title: Ineffective esophageal motility: the most common motility abnormality in patients with GERD-associated respiratory symptoms.
abstract: OBJECTIVE
  The association of gastroesophageal reflux disease (GERD) and respiratory symptoms is well known. The coexistence of ineffective esophageal motility (IEM, low-amplitude [< 30 mm Hg] or nontransmitted contractions in > or = 30% of 10 wet swallows in the distal esophagus) in patients with GERD has recently been demonstrated. Our aim was to determine the prevalence of IEM in patients with GERD-associated respiratory symptoms.
  
  
  METHODS
  Manometry and pH studies of 98 consecutive patients with respiratory symptoms and abnormal reflux shown by pH-metry were reviewed. Symptoms were chronic cough (n = 43), asthma (n = 13), and laryngitis (n = 42). Sixty-six patients with heartburn with no extraesophageal manifestations were used as a control group. Total esophageal acid clearance (EAC) time was calculated for each patient.
  
  
  RESULTS
  IEM was the most common motility abnormality seen in all groups of GERD patients. It was seen significantly more often in patients with chronic cough (41%) (p = 0.003) or asthma (53%) (p = 0.01), and numerically more often in patients with laryngitis (31%) than in patients with heartburn (19%). Diffuse esophageal spasm and nutcracker esophagus were rarely seen. Incidence of hypertensive or hypotensive lower esophageal sphincter was similar across all groups. The total EAC time was longer (median: 1.51 min/episode) (p = 0.01) in patients with GERD-associated respiratory symptoms than in patients with heartburn (median: 0.72 min/episode).
  
  
  CONCLUSIONS
  IEM is the most prevalent motility abnormality in patients with GERD-associated respiratory symptoms. Coexistence of IEM with GER may place patients at high risk for respiratory symptoms due to the associated delayed esophageal acid clearance seen with this motility abnormality.
authors.affiliation: Department of Medicine, The Graduate Hospital, Philadelphia, Pennsylvania 19146, USA.
authors.forename: Y M
authors.initials: YM
authors.lastname: Fouad
authors.forename: P O
authors.initials: PO
authors.lastname: Katz
authors.forename: J G
authors.initials: JG
authors.lastname: Hatlebakk
authors.forename: D O
authors.initials: DO
authors.lastname: Castell
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001249:Asthma / Q000209:etiology*; D002648:Child; D003371:Cough / Q000209:etiology*; D015154:Esophageal Motility Disorders / Q000175:diagnosis / Q000209:etiology*; D004947:Esophagus / Q000378:metabolism; D005260:Female; D005764:Gastroesophageal Reflux / Q000150:complications* / Q000378:metabolism; D006801:Humans; D006863:Hydrogen-Ion Concentration; D007827:Laryngitis / Q000209:etiology*; D008297:Male; D008365:Manometry; D008875:Middle Aged