Effect of acid inhibition therapy on esophageal contractility in gastroesophageal reflux patients with ineffective esophageal motility

Aims Ineffective esophageal motility (IEM) is one of the most common motility disorders, along with gastroesophageal reflux disease (GERD) [1]. The pathophysiology of IEM still needs to be elucidated. We designed our study with the theory that proton pump inhibitors (PPIs) will reverse the development of hypomotility by preventing histological deteriorations in the esophagus after recurrent acid reflux attacks with their acid suppression effect. In our study, we aimed to investigate the effect of acid inhibition therapy on esophageal contractility in patients diagnosed with IEM as a result of high-resolution manometry (HRM) and GERD as a result of multi-channel intraluminal impedance-pH (MII-pH).

Methods Our national, single-center, prospective study; A total of 45 patients who applied to various outpatient clinics of our hospital between 2023 and 2024 were diagnosed with IEM due to Chicago classification version 4.0 in HRM and were diagnosed with GERD due to Lyon consensus version 2.0 in MII-pH has been included. Patients underwent control HRM after oral treatment with esomeprazole 40 mg/day for at least 2 months. Esophagogastric junction (EGJ) contractility integral (EGJ-CI), lower esophageal sphincter pressure (LESP), distal contractility integral (DCI), integrated relaxation pressure (IRP) values ​​were examined in HRM, and these data in HRM compared with before and after PPI treatment. Additionally, when patients with acid exposure time (AET) 4-6% were excluded, a total of 38 patients with AET>6% were compared similarly among themselves.

Results When the pre-and post-treatment HRMs of a total of 45 patients were compared, p>0.05 for EGJ-CI (p=0.591), IRP (p=0.465), DCI (p=0.337), LESP (p=0.507). Therefore, no statistically significant difference was found. When the HRMs of 38 patients with AET>6% were compared, there were no significant differences for LESP (p=0.71), DCI (p=0.50), IRP (p=0.23), and EGJ-CI (p=0.63). Since p>0.05, no statistically significant difference was found.

Conclusions Our study concluded that HRM applied before and after treating patients diagnosed with IEM and GER with standard dose PPI had no effect on esophageal contractility and only the symptoms could be treated. This is the first prospective study to investigate whether PPI treatment affects IEM independently of symptoms in patients with GERD and IEM. Studies are needed to evaluate the effect of treatment on esophageal motility, including more patients and long-term follow-up after treatment.

Publication History

Article published online:
27 March 2025

• References

• 1 Lei WY, Liu TT, Wang JH, Yi CH, Hung JS, Wong MW. et al. Impact of ineffective esophageal motility on secondary peristalsis: Studies with high-resolution manometry. Neurogastroenterol Motil 2021; 33 (4): e14024