Introduction Remaining peristaltic activity of the oesophagus with multiple rapid swallows and solid swallows has been found in patients with absent contractility diagnosis. It is unknown whether the remaining motility impacts on the reflux pathology.

Aim Characterising the degree of pathological reflux in patients with absolute absent contractility and with remaining motility

Method Patients underwent high-resolution manometry (HRM) testing using Sierra Scientific Instrument (36 channel solid-state catheter and manoscan 360) between September 2014 and December 2016. 47 patients (M:F=19:28, aged 18–75 years) were diagnosed with absent contractility (according to Chicago classification [1]) and 17 of the patients showed evidence of remaining peristaltic motility (group I) during multiple rapid swallows with water and/or eating sandwich meal (normal motility with solid bolus [2]) while 30 patients maintained absolute absent contractility (group II). The lower oesophageal sphincter (LOS) tone was also assessed between 30–60s of the resting phase and size of the hiatus hernia (HH) (if present). Patients underwent reflux monitoring using Sandhill Scientific with pH-impedance catheters (ZAN-BG-44), data captured by ZepHr^TM recording device and data was analysed using Biovew Analysis. Reflux was detected when retrograde impedance flow with oesophageal pH sensor recorded pH <4.

χ² testing was employed to compare the prevalence of abnormal LOS tone and the diagnosis of GORD found in groups I and II. Student t-test was used to compare the following in groups I and II: size of HH, total acid exposure time (in minutes)(AET), total acid exposure percentage (AEP), the period of longest reflux episodes (LRE). Patients completed Reflux Disease Questionnaire (RDQ) and Hospital Odynophagia Dysphagia Questionnaire (HODQ) and their scores where compared between the groups.

Results HRM revealed 66.7% patients in group II having hypotensive LOS and 65% of patients in group I having normotensive LOS (p=0.0209). HH sizes were significantly larger in group II compared to group I (p=0.0058).

The pH data revealed patients in group II, compared to group I, have significantly higher AET (p=0.0024), AEP (p=0.0007), LPR (p=0.0024) owing to poor acid clearance (p=0.039) and RDQ scores (p=0.0285). GORD from acid exposure was found in 85% of the patients in group II while 46.7% patients in group I did not have GORD diagnosis (p=0.020). No statistical differences were found the HODQ scores (p=0.244) and age of the oesophagus (p=0.2024) between patients in both groups.

Conclusion Patients with absolute oesophageal absent contractility have shown significant association with greater degree of pathological reflux and in severity in reflux symptoms.

References

1. . Kahrilas PJ, et al. Neurogastroenterol Motil 2015;27(2):160–174.

2. . Sweis R, et al. Neurogastroenterol Motil. 2011;23(6):509-516.

Disclosure of Interest None Declared