Introduction Dysphagia is commonly reported by patients with NERD.1 In the absence of mechanical obstruction or erosions, the mechanism underlying dysphagia in NERD is unclear. Impaired oesophageal motility with delayed bolus clearance, increased resistance at the OGJ or impairment of mucosal integrity could potentially underlie this symptom. The aim of this study was to evaluate these potential causes of dysphagia in NERD patients.
Methods All adult patients, presenting to the Upper GI Physiology unit between January 2014 and October 2015, with typical GERD symptoms, normal OGD, acid exposure time > 4.2%, no major manometric abnormalities and no structural, systemic or neurologic abnormalities were included. A composite dysphagia score was prospectively recorded (0–45). Motility was evaluated using HRM and Chicago classification 2015. Bolus clearance was assessed on 24 h pH-MII using bolus exposure time and post-reflux peristaltic wave (PSPW) score. Mucosal integrity was evaluated using Mean Nocturnal Baseline Impedance (MNBI).
Results Out of the 76 eligible patients, 17 patients (8 M:9 F) with typical NERD and dysphagia symptoms (Group A) and 26 patients (15 M:11 F) with NERD only symptoms (Group B) fulfilled the inclusion criteria. Mean age for both groups was 49 years. Acid exposure time and number of reflux episodes between groups were similar (NS). The median composite dysphagia score for Group A was 19.5 (range 3.5–45). Minor oesophageal motility abnormalities were identified in 10/17 patients from Group A and 12/26 patients from Group B (P > 0.05). The median IRP was 6 mmHg in group A and 7 mmHg in group B (NS). There was no statistically significant difference in the bolus exposure time and PSPW index. Mucosal integrity evaluated with baseline impedance (MNBI) was slightly low in the distal oesophagus, without difference between groups. MNBI in the proximal oesophagus was normal and not different between groups (Table).
Conclusion 40% of NERD patients reported dysphagia; majority reporting moderately severe symptoms. Impairment of oesophageal motility, bolus clearance and mucosal integrity do not seem to explain the pathophysiology of dysphagia in these patients. Esophageal hypersensitivity to mechanical stimulation and/or hypervigilance remained as potential causes of dysphagia in patients with NERD.
Reference 1 Locke 3rd GR, et al. Prevalence and clinical spectrum of gastroesophageal reflux: A population-based study in Olmsted County, Minnesota. Gastroenterology 1997;112(5):1448–1456.
Disclosure of Interest None Declared