Dysmotility and reflux disease.
OBJECTIVE
In the last decade, with the advent of new oesophageal testing [i.e. 24-h impedance-pH monitoring, combined impedance-manometry, high-resolution manometry (HRM)], relevant progress in understanding the mechanisms contributing to the development of gastro-oesophageal reflux disease (GORD) has been made, allowing a better management of patients with this disorder. The aim of our review is to report the state-of-the-art about oesophageal motor disorders in patients with reflux disease and to stimulate new research in this field.


RESULTS
Hypotensive lower oesophageal sphincter (LOS), transient LOS relaxations, impairment of oesophagogastric junction including hiatal hernia, oesophageal bolus transit abnormalities and presence of ineffective oesophageal motility have been strongly implicated in GORD development. In particular, the majority of recent studies carried out with HRM and impedance-pH testing reported that these motor abnormalities are increasingly prevalent with increasing severity of GORD, from nonerosive reflux disease and erosive oesophagitis to Barrett's oesophagus.


CONCLUSIONS
Defining and characterizing oesophageal dysmotility in patients with reflux disease is of maximum importance in order to properly diagnose these patients and to treat them with the best management of care. New studies are needed in order to better understand the physiomechanic basis of oesophageal dysmotility in GORD patients.
aGastroenterology Unit, Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua bGastroenterology Unit, Department of Internal Medicine, University of Genoa, Genoa, Italy.
Edoardo
E
Savarino
Maria
M
Giacchino
Vincenzo
V
Savarino
D015154:Esophageal Motility Disorders / Q000150:complications* / Q000175:diagnosis* / Q000503:physiopathology; D049630:Esophageal Sphincter, Lower / Q000503:physiopathology; D050782:Esophageal pH Monitoring; D005764:Gastroesophageal Reflux / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D005772:Gastrointestinal Transit / Q000502:physiology; D006801:Humans; D008365:Manometry; D010528:Peristalsis / Q000502:physiology