İlyas TENLİK, Ömer ÖZTÜRK, Yasemin ÖZDERİN, Ferhat BACAKSIZ, Derya ARI, Orhan COŞKUN

Demographic and clinical characteristics of patients with nonspecific esophageal motility disorder

Aim: Although nonspecific esophageal motility disorder(NEMD) is the most common diagnosis in manometry, unlike other primary esophageal disorders, it is the least known and least studied disorder in the literature. Studies with a small number of patient groups have been reported in the literature. The aim of this study is to share the demographic and clinical characteristics of the single center high-volume NEMD patients we have followed up. Material and Method: The study was carried out retrospectively by examining the motility records of 391 patients diagnosed with NEMD in the motility laboratory of the gastroenterology clinic of our hospital. 20-year motility laboratory records between 1991 and 2019 were reviewed. Results: The mean age of 391 patients diagnosed with NEMD was 49.08±14.4 (18-90). 213 (54.5%) of them were female, and 178 (45.5%) of them were male. The primary symptom was reflux in 56.8% (222/391) of the patients, and dysphagia in 43.2% (169/391). While there was no esophagitis in 78.2% of the patients who had endoscopy, esophagitis was found in 21.8% of them. Pathological reflux was detected in 73.5% of the patients whose 24-hour pH was measured. In the repeated manometry results of patients due to increased complaints in their follow-up whose initial manometry findings were compatible with NEMD, 18 patients were diagnosed with achalasia, 5 patients with nutcracker esophagus, and 4 patients with diffuse esophageal spasm (DES). Conclusion: The majority of patients with NEMD are associated with reflux. Patients with NEMD who do not have endoscopic and radiological organic disorders should be re-evaluated with manometry and further examinations if their complaints persist.

Keywords:

Nonspecific esophageal motility disorder, esophageal manometry, gastroesophageal reflux,

PDF

___

Müller M, Eckardt AJ, Göpel B, Eckardt VF. Clinical and manometric course of nonspecific esophageal motility disorders. Dig Dis Sci 2012; 57: 683–89.
Ho SC, Chang CS, Wu CY, Chen GH. Ineffective esophageal motility is a primary motility disorder in gastroesophageal reflux disease. Dig Dis Sci 2002; 47: 652-56.
Richter JE, Castell DO. Diffuse esophageal spasm: a reappraisal. Ann Intern Med 1984; 100: 242–45.
Freidin N, Traube M, Mittal RK, McCallum RW. The hypertensive lower esophageal sphincter. Manometric and clinical aspects. Dig Dis Sci 1989; 34: 1063–66.
Katz PO, Dalton CB, Wu WC, Richter JE, Castell DO. Esophageal testing of patients with noncardiac chest pain or dysphagla. Results of three years’ experience with 1,161 patients. Ann Intern Med 1987; 106: 593–96.
Öztürk Ö, Kaplan M, Tenlik İ, et al. Demographic and clinical characteristics of patients with nutcracker esophagus. Erciyes Med J 2022; 44: 270-73.
Gökbulut V, Öztürk Ö, Akdoğan M, et al. Evaluation of esophageal motor functions in patients diagnosed with primary biliary cholangitis, primary sclerosing cholangitis and autoimmune hepatitis. Cukurova Med J 2021: 47, 21-28.
Kahrilas PJ, Clouse RE, Hogan WJ. American Gastroenterological Association technical review on the clinical use of esophageal manometry. Gastroenterology 1994; 107: 1865–84.
Sanderson DR, Ellis FH, Schlegel JF, Olsen AM. Syndrome of vigorous achalasia: clinical and physiological observations. Dis Chest 1967; 52: 508–17.
Richter JE, Wu WC, Johns DN, et al. Esophageal manometry in 95 healthy volunteers. Variability of pressure with age frequency of “abnormal” contractions. Dig Dis Sci 1987; 32: 583–92.
Katzka DA. Motility abnormalities in gastroesophageal reflux disease. Gastroenterol Clin North Am 1999; 28: 905–15.
Leite LP, Johnston BT, Barrett J, Castell JA, Castell DO. Ineffective esophageal motility (IEM): The primary finding in patients with nonspecific esophageal motility disorder. Dig Dis Sci 1997; 42: 1859–65.
Kahrilas PJ, Dodds WJ, Hogan WJ. Effect of peristaltic dysfunction on esophageal volume clearance. Gastroenterology 1998; 94: 73–80.
Kahrilas PJ, Dodds WJ, Hogan WJ, Kern M, Arndorfer RC, Reece A. Esophageal peristaltic dysfunction in peptic esophagitis. Gastroentology 1986; 91: 897–904.
Williams D, Thompson DG, Heggie L, O’Hanrahan T, Bancewicz J. Esophageal clearance function following treatment of esophagitis. Gastroenterology 1994; 106: 108–16.
Eriksen CA, Sadek SA, Cranford C, Sutton D, Kennedy N, Cuschieri A. Reflux oesophagitis and oesophageal transit: evidence for a primary oesophageal motor disorder. Gut 1988; 29: 448-52.
Timmer R, Breumelhof R, Nadorp JH, Smout AJ. Oesophageal motor response to reflux is not impaired in reflux oesophagitis. Gut 1993; 34: 317-20.
Achem AC, Achem SR, Stark ME, DeVault KR. Failure of esophageal peristalsis in older patients: association with esophageal acid exposure. Am J Gastroenterol 2003; 98: 35–39.
Naftali T, Levit T, Pomeranz I, Benjaminov FS, Konikoff FM. Nonspecific esophageal motility disorders may be an early stage of a specific disorder, particularly achalasia. Dis Esophagus. 2009; 22: 611–15.
Achem SR, Crittenden J, Kolts B, Burton L. Long-term clinical and manometric follow-up of patients with nonspecific esophageal motor disorders. Am J Gastroenterol. 1992; 87: 825–30.
Vantrappen G, Janssens J, Hellemans J, Coremans G. Achalasia, diffuse esophageal spasm, and related motility disorders. Gastroenterology. 1979; 76: 450–57.