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.
