How effective are we at understanding ineffective esophageal motility?

摘要

Ineffective esophageal motility has been with us since the development of perfused and, more recently, solid state esophageal motility testing. Previously described by various laboratories with a variety of terms, such as "failed peristalsis," "ineffective peristalsis," "dropped waves," "nonspecific motility disorder," etc, its definition and nomenclature were standardized by Spechler and Castell, who defined the criteria for the diagnosis of ineffective esophageal motility as a disorder with low or normal esophageal sphincter pressure, normal lower esophageal sphincter (LES) relaxation, and greater than 30% low-amplitude waves, some of which may not be peristaltic. Although ineffective esophageal motilityneffective esophageal motility with GERD and suggeste has prompted investigative work by laboratories on all continents, its pathophysiology and clinical significance are still being debated. CastelPs group linked id that it was a highly specific (91%), albeit not sensitive (45%), indicator of supine GERD on proton pump inhibitors.2 A more recent study, by Fornari et al, confirmed an association of GERD with ineffective esophageal motility, independent of other GERD risk factors, such as a low LES pressure, hiatus hernia, and male sex. Other investigators documented that GERD-associated ineffective esophageal motility improves after Nissen fundoplication and that its presence is not a manometric contraindication to antireflux surgery