In ineffective esophageal motility, failed swallows are more functionally relevant than weak swallows

Area of Science:

• Gastroenterology
• Esophageal Physiology
• Diagnostic Tools

Background:

• Esophageal pressure topography (EPT) diagnosis of ineffective esophageal motility (IEM) can be non-specific.
• The clinical significance of IEM diagnosis requires further clarification.

Purpose of the Study:

• To investigate the association between peristaltic vigor and lower esophageal sphincter (LES) integrity with poor bolus clearance and acid reflux in IEM patients.

Main Methods:

• Retrospective review of high-resolution impedance manometry (HRIM) and reflux studies in 88 IEM patients.
• Assessment of bolus clearance using line tracing and colored contour methods.
• Exploration of EPT parameters, bolus clearance, and acid reflux variables.

Main Results:

• Bolus clearance occurred in 71% of swallows; 55.7% of patients achieved complete bolus transit (CBT).
• Impaired bolus clearance was associated with distal contractile integral (DCI) <100 mmHg·cm·s (0.43 vs 0.79, P < .0001).
• A DCI cutoff of 100 mmHg·cm·s accurately predicted clearance (76% accuracy). Lower DCI correlated with higher Eckardt scores and abnormal acid exposure.

Conclusions:

• Failed peristalsis (DCI <100 mmHg·cm·s) is linked to impaired bolus clearance and more severe dysphagia in IEM.
• This finding suggests a potential association with abnormal acid exposure, impacting patient outcomes.