Impaired motility in Barrett's esophagus: A study using high-resolution manometry with physiologic challenge

S Sanagapalli; A Emmanuel; R Leong; S Kerr; L Lovat; R Haidry; M Banks; D Graham; A Raeburn; N Zarate-Lopez; R Sweis

doi:10.1111/nmo.13330

Impaired motility in Barrett's esophagus: A study using high-resolution manometry with physiologic challenge

Neurogastroenterol Motil. 2018 Mar 15. doi: 10.1111/nmo.13330. Online ahead of print.

Authors

S Sanagapalli¹, A Emmanuel¹, R Leong¹, S Kerr¹, L Lovat¹, R Haidry¹, M Banks¹, D Graham¹, A Raeburn¹, N Zarate-Lopez¹, R Sweis¹

Affiliation

¹ GI Physiology Unit, University College London Hospital, London, UK.

PMID: 29542847
DOI: 10.1111/nmo.13330

Abstract

Background: Esophageal dysmotility may predispose to Barrett's esophagus (BE). We hypothesized that high-resolution manometry (HRM) performed with additional physiologic challenge would better delineate dysmotility in BE.

Methods: Included patients had typical reflux symptoms and underwent endoscopy, HRM with single water swallows and adjunctive testing with solids and rapid drink challenge (RDC) before ambulatory pH-impedance monitoring. BE and endoscopy-negative reflux disease (ENRD) subjects were compared against functional heartburn patient-controls (FHC). Primary outcome was incidence of HRM contractile abnormalities with standard and adjunctive swallows. Secondary outcomes included clearance measures and symptom association on pH-impedance.

Key results: Seventy-eight patients (BE 25, ENRD 27, FHC 26) were included. Water swallow contractility was reduced in both BE (median DCI 87 mm Hg/cm/s) and ENRD (442 mm Hg/cm/s) compared to FHC (602 mm Hg/cm/s; P < .001 and .04, respectively). With the challenge of solid swallows and RDC, these parameters improved in ENRD (solids = 1732 mm Hg/cm/s), becoming similar to FHC (1242 mm Hg/cm/s; P = .93), whereas abnormalities persisted in BE (818 mm Hg/cm/s; P < .01 c.f. FHC). In BE and ENRD, reflux events (67 vs 57 events/24 hour) and symptom frequency were similar; yet symptom correlation was significantly better in ENRD compared to BE, which was comparable to FHC (symptom index 30% vs 4% vs 0%, respectively). Furthermore, bolus clearance and exposure times were more pronounced in BE (P < .01).

Conclusions & inferences: Reduced contractile effectiveness persisted in BE with the more representative esophageal challenge of swallowing solids and free drinking; while in ENRD and FHC peristalsis usually improved, demonstrating peristaltic reserve. Furthermore, symptom association and refluxate clearance were reduced in BE. These factors may underlie BE pathogenesis.

Keywords: Barrett's esophagus; dysmotility; gastro-esophageal reflux disease; high-resolution manometry; peristaltic reserve.