Ineffective Esophageal Motility with and Without Abnormal Acid Exposure: Clinical, Endoscopic, and Manometric...

Ineffective esophageal motility (IEM) is the most common esophageal motility disorder. Reflux is common in patients with IEM. The relationship between IEM and gastroesophageal reflux disease is not fully understood. The current study evaluated the associations between clinical, endoscopic, and manometric characteristics and acid exposure in patients with IEM.

The authors prospectively enrolled patients diagnosed with IEM who underwent high-resolution manometry according to the Chicago classification, version 4.0. Patients were classified into pathological and physiological reflux groups based on multichannel intraluminal impedance-pH ( MII-pH) monitoring results. Clinical, endoscopic, manometric, and MII-pH parameters were compared between the 2 groups.

Of the 69 patients, 49 (71%) had pathological reflux and 20 (29%) had physiological reflux. The most frequent symptoms were heartburn, regurgitation, and dysphagia. No significant differences were observed between the 2 groups in demographic, clinical, or endoscopic characteristics. Among the manometric metrics, mean lower esophageal sphincter pressure and esophagogastric junction (EGJ) morphology differed significantly between the 2 groups (P = .017 and P = .046, respectively). All MII‑pH metrics, except weak acid reflux episodes and nonacid reflux episodes, differed significantly between the groups (P <.05).

Acid exposure did not affect symptoms in patients with IEM. In addition to impaired esophageal body contractility, impaired esophageal clearance and EGJ barrier dysfunction may contribute to acid exposure.