Ineffective motility: Can it be used as a marker for GERD?.

To prospectively examine the relationship of esophageal motility and esophageal acid exposure in patients with classis GERD and those with extra-esophageal GERD manifestations
Methods: A prospective study of 55 consecutive patients referred to our motility unit for GERD symptoms. Patients were categorized as: esophageal and extraesophageal. Only patients with both manometric and pH-metry studies were included in the analysis. Therefore the study population was 29 patients. Associations between diagnostic category, motility disorder, and abnormal reflux were evaluated with contingency-table analyses
Results: Groups were analyzed according to the presence or absence of a motility disorder: Group A-those with esophageal manifestations with or without abnormal acid exposure, and Group B-those patients with extra-esophageal manifestations with or without abnormal acid exposure. Twenty-four (24) patients had esophageal symptoms and five (5) had supraesophageal symptoms. Fifteen patients (52 percent) had abnormal acid exposure. The prevalence of abnormal acid exposure between patients with esophageal and extra-esophageal symptoms (54 percent vs 40 percent, p=.651) were similar. Ineffective motility was identified in 9 patients (31 percent) [vs 10 percent in normal historical controls]. IEM was the only primary motility disorder identified. The incidence of IEM among patients with reflux symptoms whether or not they had abnormal acid exposure (33 percent vs 29 percent, p
Conclusions: IEM can be viewed as a specific entity or primary esophageal motility disorder in patients with GERD. IEM in and of itself does not reliably distinguish classic GERD from extra-esophageal reflux disease, hence, cannot be used as marker for the presence of extra-esophageal disease. (Author)