title: Oesophageal motility and bolus transit abnormalities increase in parallel with the severity of gastro-oesophageal reflux disease.
abstract: BACKGROUND
  Limited data are available regarding the frequency of oesophageal motility and bolus transit abnormalities in subgroups of patients with gastro-oesophageal reflux disease (GERD).
  
  
  OBJECTIVE
  To assess oesophageal motility and bolus transit in endoscopically defined GERD subgroups.
  
  
  METHODS
  Patients (N=755) with typical reflux symptoms underwent upper endoscopy, conventional or impedance oesophageal manometry and/or impedance-pH testing. They were divided into: erosive oesophagitis (EO; N=340), Barrett Oesophagus (BO; N=106), non-erosive reflux disease (NERD; endoscopy-, abnormal pH and/or SAP/SI+; N=239) and functional heartburn (FH; endoscopy-, normal pH and SAP/SI-; N=70). Manometric patterns and bolus transit were defined according to previously published criteria.
  
  
  RESULTS
  Increasing GERD severity was associated with decreased lower oesophageal sphincter resting pressure (P< 0.05) and distal oesophageal amplitude (P<0.01), higher prevalence of hiatal hernia (P<0.01) and increased prevalence of ineffective oesophageal motility (P<0.01). Patients with EO and BO had a significantly lower percentage of complete bolus transit compared with NERD and FH (P<0.01). Overall, abnormal bolus transit (ABT) for liquid swallows was found in 12% of FH, 20% of NERD, 54% of EO and 56% of BO (P<0.01). Combined impedance-manometry showed abnormal oesophageal function in 4% of FH, 4% of NERD, 22% of EO and 21% of BO patients with normal oesophageal manometry.
  
  
  CONCLUSIONS
  Oesophageal motility abnormalities increase in parallel with the severity of GERD from NERD to EO and BO. Bolus transit abnormalities in severe reflux disease underscore the importance of impaired oesophageal function in the development of mucosal injury.
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, University of Genoa, Genoa, Italy. edoardo.savarino@unige.it
authors.forename: E
authors.initials: E
authors.lastname: Savarino
authors.forename: L
authors.initials: L
authors.lastname: Gemignani
authors.forename: D
authors.initials: D
authors.lastname: Pohl
authors.forename: P
authors.initials: P
authors.lastname: Zentilin
authors.forename: P
authors.initials: P
authors.lastname: Dulbecco
authors.forename: L
authors.initials: L
authors.lastname: Assandri
authors.forename: E
authors.initials: E
authors.lastname: Marabotto
authors.forename: D
authors.initials: D
authors.lastname: Bonfanti
authors.forename: S
authors.initials: S
authors.lastname: Inferrera
authors.forename: V
authors.initials: V
authors.lastname: Fazio
authors.forename: A
authors.initials: A
authors.lastname: Malesci
authors.forename: R
authors.initials: R
authors.lastname: Tutuian
authors.forename: V
authors.initials: V
authors.lastname: Savarino
mesh_terms: D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D017097:Electric Impedance; D050782:Esophageal pH Monitoring; D005260:Female; D005745:Gastric Acidity Determination; D005764:Gastroesophageal Reflux / Q000150:complications / Q000503:physiopathology*; D005769:Gastrointestinal Motility / Q000502:physiology*; D005772:Gastrointestinal Transit / Q000502:physiology*; D006801:Humans; D007558:Italy; D008297:Male; D008365:Manometry / Q000379:methods; D008875:Middle Aged; D010528:Peristalsis / Q000502:physiology*; D011446:Prospective Studies; D012044:Regression Analysis; D012189:Retrospective Studies; D012720:Severity of Illness Index; D055815:Young Adult