title: Relevance of ineffective esophageal motility to secondary peristalsis in patients with gastroesophageal reflux disease.
abstract: OBJECTIVE
  The study aimed to investigate the hypothesis whether the presence of Ineffective esophageal motility would affect physiological characteristics of secondary peristalsis.
  
  
  METHODS
  Secondary peristalsis was performed with slow and rapid air injections into mid-esophagus of 18 ineffective esophageal motility patients and 15 age-matched controls. Severity of ineffective esophageal motility was defined by the application of combined multichannel intraluminal impedance and manometry.
  
  
  RESULTS
  Ineffective esophageal motility patients included 11 patients without impedance abnormality and seven patients with impedance abnormality during liquid and/or viscous swallowing. The prevalence of failed secondary peristaltic response during slow air injection was significantly greater in ineffective esophageal motility patients without impedance abnormality (3/11 [27%], P < 0.001) and with impedance abnormality (4/7 [57%], P = 0.04) than healthy subjects. The threshold volume for inducing secondary peristalsis during rapid air injection was significantly greater in ineffective esophageal motility patients with impedance abnormality (6.1 ± 0.3 mL) than healthy subjects (4.6 ± 0.3 mL, P < 0.05) and ineffective esophageal motility patients without impedance abnormality (4.1 ± 0.4 mL, P < 0.05). The frequency of peristaltic response during rapid air injection was significantly lower in ineffective esophageal motility patients with impedance abnormality (40% [20-50%] than healthy subjects (90% [90-100%], P < 0.05).
  
  
  CONCLUSIONS
  Defective activation of secondary peristalsis is present in ineffective esophageal motility patients with impedance abnormality. Our study indicates that increased ineffective esophageal motility severity associated with defective triggering of secondary peristalsis may contribute to impaired esophageal clearance in patients with gastroesophageal reflux disease.
authors: Department of Medicine, Buddhist Tzu Chi General Hospital and Tzu Chi University, Hualien, Taiwan.
authors: Chien-Lin
authors: CL
authors: Chen
authors: Chih-Hsun
authors: CH
authors: Yi
authors: Tso-Tsai
authors: TT
authors: Liu
mesh_terms: D000328:Adult; D000368:Aged; D015154:Esophageal Motility Disorders / Q000209:etiology / Q000503:physiopathology*; D005260:Female; D005764:Gastroesophageal Reflux / Q000209:etiology / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010528:Peristalsis; D011446:Prospective Studies; D012720:Severity of Illness Index
keywords: gastroesophageal reflux disease; ineffective esophageal motility; secondary peristalsis