title: Differences in esophageal corpus motility in patients with pathological and non-pathological gastroesophageal reflux.
abstract: BACKGROUND
  First- and second-order esophageal contractions are important factors responsible for esophageal clearance of refluxed gastric content. The aim of this study was to estimate the influence of acid reflux on second-order esophageal peristalsis.
  
  
  METHODS
  Simultaneous 24-h esophageal pH-metry and 24-h motility monitoring was performed in 213 patients with non-cardiac chest pain. Pathological gastroesophageal acid reflux (pGER) was defined as pH <4 for more than 4.5% of the total monitoring time.
  
  
  RESULTS
  The group of pGER patients (n=65, 31%) had a lower percentage of complete and effective peristalsis, a higher percentage of incomplete peristalsis, and a lower mean contraction amplitude than the group of patients with normal esophageal acid exposure (nGER). Analysis of motility parameters in three periods, i.e. during acid reflux and 2 min before and 10 min after episodes (second-order peristalsis), showed that the pGER group had a lower percentage of effective peristalsis (20.6 +/- 13.3 vs. 29.6 +/- 16.2%, p = 0.002) and a higher percentage of ineffective peristalsis both during and after acid reflux, a lower mean contraction amplitude (56.5 +/- 30.3 vs. 70.0 +/- 32.8 mmHg, p=0.025), and a lower contraction frequency during acid reflux (1.6 +/- 0.7 vs. 2.6 +/- 3.1/min, p=0.001) and 10 min after (1.9 +/- 1.9 vs. 20.6 +/- 30.2/min, p=0.002), which indicated a lack of esophageal peristalsis acceleration after acid reflux in the pGER group.
  
  
  CONCLUSIONS
  (1) pGER patients had ineffective esophageal peristalsis more frequently than nGER patients. (2) Impaired second-order peristalsis in pGER patients may be an important factor determining prolonged exposure of the esophageal mucosa to gastric content in addition to lower esophageal sphincter function.
authors.affiliation: Department of Gastroenterology, Vascular Diseases, and Internal Medicine, Nicolaus Copernicus University, Collegium Medicum in Bydgoszcz, Poland. mariaklopocka@wp.pl
authors.forename: Maria
authors.initials: M
authors.lastname: Klopocka
authors.forename: Jacek
authors.initials: J
authors.lastname: Budzyński
authors.forename: Maciej
authors.initials: M
authors.lastname: Swiatkowski
authors.forename: Grzegorz
authors.initials: G
authors.lastname: Pulkowski
authors.forename: Agnieszka
authors.initials: A
authors.lastname: Meder
mesh_terms: D000328:Adult; D015154:Esophageal Motility Disorders / Q000503:physiopathology*; D004947:Esophagus / Q000503:physiopathology*; D005764:Gastroesophageal Reflux / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010528:Peristalsis