Esophageal Dysmotility Increases with the Severity of Gastroesophageal Reflux Disease: A Study Using High Resolution Manometry and the Revised Chicago Classification Criteria

Purpose: Past studies utilizing the conventional manometric definition of Ineffective Esophageal Motility have yielded conflicting results regarding the prevalence of dysmotility among GERD subgroups. Recently, the International High Resolution Manometry (HRM) Working Group issued new definitions for peristaltic function using the Chicago Classification (CC). The purpose of this study was to apply the new CC criteria to determine the prevalence of dysmotility among patients with Erosive Esophagitis (EE), Non-Erosive Reflux Disease (NERD) and Functional Heartburn (FH). Methods: A retrospective review of 150 patients who underwent HRM for GERD symptoms was performed. Patients were divided into 3 groups based upon endoscopic and esophageal pH or impedance testing: 1) EE (Esophagitis on EGD) (n=50), 2) NERD (normal EGD and pathological acid exposure on pH Testing or > 48 reflux events on impedance) (n=63), 3) FH (normal EGD, normal pH or impedance) (n=37). HRM studies were then characterized using the CC for peristaltic abnormalities and Esophagogastric Junction (EGJ) types. Results: The most common pattern among FH patients was normal motility (68%) which was higher than in the EE (12%, p<0.0001) and NERD (37%, p=0.004) groups. The FH group could be distinguished from NERD patients with lower rates of Weak Peristalsis with Large Peristaltic Defects (Figure 1). Comparisons between FH and EE yielded lower rates for Absent Peristalsis (0% vs 14%, p=0.018), Frequent Failed Peristalsis (0% vs 14%, p=0.018) and Weak Peristalsis with Large Peristaltic Defects (14% vs 42%, p=0.005). EE patients could be distinguished from the NERD group based upon higher rates of Absent Peristalsis (Figure 1). EGJ type 2 (1-2 cm separation between the crural diaphragm and lower esophageal sphincter) was more common in EE (30%) and NERD (29%) than in FH (11%) (p=0.038, p=0.047). EGJ type 3 (> 2 cm separation) also differentiated EE (20%) patients from FH (3%) (p=0.021).Figure: Prevalence of motility patterns among gerd subtypes using the revised chicago classification for high resolution esophageal manometry.Conclusion: HRM patterns for peristaltic dysfunction and the EGJ are different among GERD subgroups. Esophageal dysmotility characterized by the new Chicago Classification guidelines increases with the severity of esophageal acid exposure.