title: Weak peristalsis with large breaks is associated with higher acid exposure and delayed reflux clearance in the supine position in GERD patients.
abstract: OBJECTIVE
  Ineffective esophageal motility is frequently observed in gastroesophageal reflux disease (GERD) patients but its clinical relevance remains controversial. In healthy subjects and in patients with nonobstructive dysphagia, it has been demonstrated, by means of high-resolution manometry (HRM), that long breaks of esophageal peristalsis predict delayed bolus clearance.
  
  
  METHODS
  HRM and 24-h multichannel impedance-pH (MI-pH) monitoring were performed in 40 GERD patients with no evidence of hiatal hernia. Total bolus clearing time (BCT) in upright and supine position and acid exposure time (AET) were calculated.
  
  
  RESULTS
  Of the 40 patients, 23 showed a pathological AET and 15 erosive reflux disease (ERD). Patients with a pathological number of large breaks were characterized by a significantly lower BCT value in the supine position and higher AET. In all, 10/15 ERD patients (67%) and 5/25 nonerosive reflux disease patients (20%) were characterized by an abnormal number of small or large breaks (P<0.05). ERD patients were characterized by significantly higher AET and BCT in the supine position.
  
  
  CONCLUSIONS
  GERD patients with a pathological number of large breaks, assessed by HRM, are characterized by a significantly prolonged reflux clearance in the supine position and higher AET. ERD patients display a higher number of esophageal breaks that might explain the development of erosions.
authors.affiliation: Unit of Digestive Disease, Campus Bio Medico University, Rome, Italy.
authors.forename: Mentore
authors.initials: M
authors.lastname: Ribolsi
authors.affiliation: Unit of Digestive Disease, Campus Bio Medico University, Rome, Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Balestrieri
authors.affiliation: Unit of Digestive Disease, Campus Bio Medico University, Rome, Italy.
authors.forename: Sara
authors.initials: S
authors.lastname: Emerenziani
authors.affiliation: Unit of Digestive Disease, Campus Bio Medico University, Rome, Italy.
authors.forename: Michele Pier Luca
authors.initials: MP
authors.lastname: Guarino
authors.affiliation: Unit of Digestive Disease, Campus Bio Medico University, Rome, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Cicala
mesh_terms: D000328:Adult; D050782:Esophageal pH Monitoring; D004947:Esophagus / Q000473:pathology / Q000503:physiopathology*; D005260:Female; D005744:Gastric Acid / Q000378:metabolism*; D005764:Gastroesophageal Reflux / Q000175:diagnosis / Q000378:metabolism / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010528:Peristalsis / Q000502:physiology*; D012720:Severity of Illness Index; D013223:Statistics as Topic; D016683:Supine Position / Q000502:physiology*; D013997:Time Factors