Role of Esophageal Motility, Acid Reflux, and of Acid Suppression in Non-obstructive Dysphagia.


eMediNexus    14 October 2017

A recent study published in the Journal of Clinical Gastroenterology aimed to evaluate the role of high-resolution manometry (HRM) findings, presence of gastroesophageal reflux disease (GERD), and proton-pump inhibitor (PPI) therapy on dysphagia perception, among dysphagic patients. In this study, 37 non-erosive reflux disease (NERD) patients with only dysphagia (group 1) and 52 patients with both dysphagia and typical GERD symptoms (group 2) were evaluated with symptom scores, HRM combined with impedance, and 24 hours impedance-pH monitoring. Overall, 44 NERD patients, not presenting dysphagia, underwent the same protocol. Twenty two of group 1 patients [11 with pathologic acid exposure time (AET)] were treated with esomeprazole 40 mg oid for 4 weeks, and were reassessed during the last week of therapy. The findings showed that 40% of group 1 patients, 52% of group 2 patients, and 43% of NERD patients presented pathologic AET. Additionally, group 1 patients with a pathologic AET showed a marked lower mean distal contractile integral (DCI) and a significant correlation between individual DCI and total bolus transit time values. Furthermore, during PPI therapy, the mean dysphagia score value decreased considerably and the mean DCI value increased significantly, in group 1 patients with pathologic AET. The results were summarized as: in 40% of dysphagic patients exhibiting a pathologic AET and reduced peristaltic vigor, an adequate PPI therapy significantly decreases dysphagia frequency and severity and improves the esophageal peristaltic force.1Reference1. Ribolsi M, Biasutto D, Giordano A, Balestrieri P, Cicala M. Role of Esophageal Motility, Acid Reflux, and of Acid Suppression in Nonobstructive Dysphagia. Journal of Clinical Gastroenterology. 2017:1. doi:10.1097/mcg.0000000000000903.

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