Evaluation of esophageal motor function in patients with gastroesophageal reflux using multiple rapid swallows

Multiple rapid swallow (MRS) is a complementary test performed during high-resolution esophageal manometry (HREM). The present study was done to assess the MRS findings in patients with gastroesophageal reflux disease (GERD) who have normal peristalsis and minor motility disorders. This is a retrospective analysis from a prospectively maintained database of patients referred for HREM study to our center. The recorded details included age, sex, symptoms with duration, and upper gastrointestinal endoscopy reports. HREM data included basal inspiratory and expiratory pressures, median integrated relaxation pressure, and peristaltic pattern. Three MRS sequences were recorded per patient. The inhibition and contraction phases were interpreted for each MRS sequence. A total of 68 patients (38 normal motility, 30 minor motility disorders) formed the study cohort. Hiatus hernia was common in GERD patients with minor motility disorders (p 0.02). Patients with minor motility disorders were more likely to have poor peristaltic reserve than patients with normal peristalsis (p < 0.05). MRS patterns in inhibition and contraction phases were similar in the three MRS sequences for patients with normal peristalsis, while in patients with minor peristaltic disorders, the inhibition phase was significantly discordant on repetitive MRS (p 0.049). Thus, in GERD patients, those with normal peristalsis were more likely to have normal MRS pattern. On the contrary, those with minor peristaltic disorders had a higher frequency of poor peristaltic reserve and show significant discordance in the inhibition phase of MRS.