Is all ineffective esophageal motility the same? A clinical and high-frequency intraluminal US study.
BACKGROUND
Ineffective esophageal motility (IEM) is characterized by frequent hypotensive or failed peristaltic contractions; its pathophysiology is controversial.


OBJECTIVE
To evaluate whether patients with IEM because of GERD would differ from patients with other etiologies of IEM on the basis of esophageal-muscle thickness measured by high-frequency intraluminal US (HFIUS).


METHODS
Single-center prospective study.


METHODS
Academic medical center; from January 2004 to June 2005.


METHODS
A total of 46 patients who were newly diagnosed with IEM were classified into 2 groups: GERD-related IEM (group I, n = 26) and non-GERD-related IEM (group II, n = 20) on the basis of the presence of reflux esophagitis and/or pathologic acid exposure by 24-hour esophageal pH monitoring. In addition, 16 asymptomatic healthy volunteers with no reflux esophagitis, normal manometric finding, and normal level of acid exposure were included as controls.


METHODS
We compared the clinical characteristics, including a predominant principal esophageal symptom and the results from HFIUS among the control, GERD-related IEM (group I), and non-GERD-related IEM (group II) groups.


RESULTS
The proportion of typical reflux symptom as a predominant symptom was higher in group I (66%) than in group II (25%). Muscle thickness was greater in group II than in group I and the control group during both the baseline rest period and the peak of contraction period at all levels of the middle of the lower esophageal sphincter (LES), and 3 cm and 9 cm above the LES (respectively) (P < .05).


CONCLUSIONS
The limitation was the small sample size.


CONCLUSIONS
Patients with non-GERD-related IEM had increased muscle thickness on HFIUS compared with patients with GERD-related IEM and the controls. Based on this study, IEM is not necessarily indicative of GERD.
Kim
Jeong Hwan
JH
Department of Internal Medicine, Konkuk University School of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Rhee
Poong-Lyul
PL
Son
Hee Jung
HJ
Song
Keun Jeong
KJ
Kim
Jae J
JJ
Rhee
Jong Chul
JC
D000046:Academic Medical Centers; D000328:Adult; D016022:Case-Control Studies; D019160:Endosonography / Q000379:methods*; D015154:Esophageal Motility Disorders / Q000150:complications / Q000000981:diagnostic imaging* / Q000473:pathology*; D050782:Esophageal pH Monitoring; D004942:Esophagitis, Peptic / Q000150:complications / Q000000981:diagnostic imaging* / Q000473:pathology*; D004945:Esophagoscopy / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D005764:Gastroesophageal Reflux / Q000150:complications / Q000000981:diagnostic imaging / Q000473:pathology; D006801:Humans; D008297:Male; D008365:Manometry; D008875:Middle Aged; D018670:Monitoring, Ambulatory; D009130:Muscle, Smooth / Q000000981:diagnostic imaging / Q000473:pathology*; D011336:Probability; D011446:Prospective Studies; D012016:Reference Values; D018570:Risk Assessment; D012680:Sensitivity and Specificity