Impaired motility in Barrett's esophagus: A study using high-resolution manometry with physiologic challenge

Area of Science:

• Gastroenterology
• Esophageal Physiology
• High-Resolution Manometry

Background:

• Esophageal dysmotility is a potential risk factor for Barrett's esophagus (BE).
• High-resolution manometry (HRM) with physiologic challenges may better identify dysmotility in BE.

Purpose of the Study:

• To evaluate the utility of HRM with adjunctive swallow challenges in differentiating esophageal dysmotility in BE.
• To compare contractile abnormalities, reflux events, and symptom association in BE, endoscopy-negative reflux disease (ENRD), and functional heartburn (FHC) patients.

Main Methods:

• Patients with reflux symptoms underwent HRM with water, solids, and rapid drink challenge (RDC), followed by pH-impedance monitoring.
• Contractile abnormalities, bolus clearance, and symptom association were assessed.
• BE, ENRD, and FHC groups were compared.

Main Results:

• Reduced esophageal contractility was observed in BE and ENRD compared to FHC with standard water swallows.
• While ENRD patients showed improved contractility with solids and RDC (peristaltic reserve), BE patients exhibited persistent abnormalities.
• BE patients had impaired bolus clearance and reduced symptom association compared to ENRD and FHC groups.

Conclusions:

• Persistent esophageal contractile dysfunction in BE, even with challenging swallows, suggests a role in pathogenesis.
• The presence of peristaltic reserve in ENRD and FHC differentiates them from BE.
• Impaired refluxate clearance and symptom association in BE may contribute to its development.