Factors Predicting Peristaltic Abnormalities in Gastroesophageal Reflux

Abstract

Background : Data regarding the type of breaks and its impact on peristalsis in gastro esophageal reflux disease(GERD) is scanty. Aim : To study the prevalence and significance of segmental breaks in symptomatic GERD cases. To identify the endoscopy grading and dietary factors that are likely to affect esophageal motility. Materials and Methods : 106 patients with GERD were included. Baseline patient information included age, gender, BMI, diet recall and upper endoscopy report.Normal (Group I) and ineffective swallows (Group II, minor peristaltic defects) were compared for proximal and distal segment breaks . Impact of multiple rapid swallows was assessed in a subset of cases.Appropriate statistical tests were used. p value <0.05 was considered as statistically significant. Results : 72 patients had normal esophageal motility (Group I) and 30 had minor peristalitc abnormality (Group II). BMI was significantly higher in Group II. Mean basal LES pressure, IRP and DCI in Group II was significantly low and a significant proportion of swallows in patients in Group II had breaks greater than 5 cm in S1 and more than 2 cm in S2 and S3. The basal LES pressure and BMI cut off was 12.1 mm Hg and 26.1 kg per m2respectively. The odds ratio of having a minor peristaltic disorder was 3.2 times(1.4-4.1, p 0.001) with the combination of these two factors. Conclusion : Majority of GERD patients had normal motility. Even in those with minor peristaltic abnormality, the peristaltic reserve was good.Patients in group II had significantly lower basal LES pressures and higher BMI.