title: Esophageal motility abnormalities in gastroesophageal reflux disease.
abstract: Esophageal motility abnormalities are among the main factors implicated in the pathogenesis of gastroesophageal reflux disease. The recent introduction in clinical and research practice of novel esophageal testing has markedly improved our understanding of the mechanisms contributing to the development of gastroesophageal reflux disease, allowing a better management of patients with this disorder. In this context, the present article intends to provide an overview of the current literature about esophageal motility dysfunctions in patients with gastroesophageal reflux disease. Esophageal manometry, by recording intraluminal pressure, represents the gold standard to diagnose esophageal motility abnormalities. In particular, using novel techniques, such as high resolution manometry with or without concurrent intraluminal impedance monitoring, transient lower esophageal sphincter (LES) relaxations, hypotensive LES, ineffective esophageal peristalsis and bolus transit abnormalities have been better defined and strongly implicated in gastroesophageal reflux disease development. Overall, recent findings suggest that esophageal motility abnormalities are increasingly prevalent with increasing severity of reflux disease, from non-erosive reflux disease to erosive reflux disease and Barrett's esophagus. Characterizing esophageal dysmotility among different subgroups of patients with reflux disease may represent a fundamental approach to properly diagnose these patients and, thus, to set up the best therapeutic management. Currently, surgery represents the only reliable way to restore the esophagogastric junction integrity and to reduce transient LES relaxations that are considered to be the predominant mechanism by which gastric contents can enter the esophagus. On that ground, more in depth future studies assessing the pathogenetic role of dysmotility in patients with reflux disease are warranted.
authors.affiliation: Irene Martinucci, Nicola de Bortoli, Santino Marchi, Division of Gastroenterology, University of Pisa, 56124 Pisa, Italy.
authors.forename: Irene
authors.initials: I
authors.lastname: Martinucci
authors.affiliation: Irene Martinucci, Nicola de Bortoli, Santino Marchi, Division of Gastroenterology, University of Pisa, 56124 Pisa, Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: de Bortoli
authors.affiliation: Irene Martinucci, Nicola de Bortoli, Santino Marchi, Division of Gastroenterology, University of Pisa, 56124 Pisa, Italy.
authors.forename: Maria
authors.initials: M
authors.lastname: Giacchino
authors.affiliation: Irene Martinucci, Nicola de Bortoli, Santino Marchi, Division of Gastroenterology, University of Pisa, 56124 Pisa, Italy.
authors.forename: Giorgia
authors.initials: G
authors.lastname: Bodini
authors.affiliation: Irene Martinucci, Nicola de Bortoli, Santino Marchi, Division of Gastroenterology, University of Pisa, 56124 Pisa, Italy.
authors.forename: Elisa
authors.initials: E
authors.lastname: Marabotto
authors.affiliation: Irene Martinucci, Nicola de Bortoli, Santino Marchi, Division of Gastroenterology, University of Pisa, 56124 Pisa, Italy.
authors.forename: Santino
authors.initials: S
authors.lastname: Marchi
authors.affiliation: Irene Martinucci, Nicola de Bortoli, Santino Marchi, Division of Gastroenterology, University of Pisa, 56124 Pisa, Italy.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Savarino
authors.affiliation: Irene Martinucci, Nicola de Bortoli, Santino Marchi, Division of Gastroenterology, University of Pisa, 56124 Pisa, Italy.
authors.forename: Edoardo
authors.initials: E
authors.lastname: Savarino
keywords: Esophagogastric junction; Gastroesophageal reflux disease; High-resolution manometry; Ineffective esophageal motility; Transient lower esophageal sphincter relaxations