Motor abnormalities in erosive gastroesophageal reflux disease

V. Kaibysheva, E.D. Fedorov, S. Shapovaliantc

Pirogov Russian National Research Medical University (RNRMU), Moscow, Russian Federation

Contact E-Mail Address: valeryslove(a)

Introduction: The Chicago Classification of esophageal motility disorders is not designed to evaluate motor function in gastroesophageal reflux disease (GERD)[1]. The aim of the study is to assess manometrical abnormalities in erosive GERD.

Aims and Methods: 127 patients (75 women, age 28–78 years) with esophagitis LA Grade B,C,D. Esophageal high resolution manometry (HRM), 24-h esophageal impedance-pH monitoring were performed in all patients after upper endoscopy.

Esophagogastric junction contractile integral (EGJ-CI) was calculated during 3 respiratory cycles using the distal contractile integral (DCI) box. The calculated ‘DCI’ was then divided by the duration of the 3 respiratory cycles [2].

Results: According to esophageal impedance-pH monitoring pathological acid exposure time (AET46%) [2] was detected only in 115 (90.5%) patients, so the remaining 12 (9.5%) were excluded from further evaluation. Among 115 GERDpatients HRM revealed ineffective esophageal motility (IEM) in 44 (38.3%), absent contractility in 6 (5.2%), fragmented peristalsis in 2 (1.7%), normal esophageal motility in 63 (54.8%) patients. Esophageal manometry also assessed esophagogastric junction (EGJ) morphology [2]: type I was detected in 71 (62%), type II in 24 (20.7%), type III (≤3 cm separation between the LES and CD) in 20 (17.3%) patients. Basal LES pressure (median (5th–95th percentile)) in GERD patients was 10.7 (4.4–15.3) mm Hg, median EGJ-CI was 21.3 (10.4–38.6) mm Hg. Among 44 patients with IEM multiple rapid swallows revealed contraction reserve (post-MRS contraction has greater vigor than the preceding test swallows) in 12 (27.3%) patients, while 6 patients (100%) with absent contractility demonstrated absent post-MRS contraction.

Conclusion: Manometrical abnormalities in GERD include low basal LES pressure and low EGJ-CI (in comparison to normal values) [3], hiatal hernia, esophageal body hypomotility, absence of contraction reserve.

Disclosure: Nothing to disclose


  1. Kahrilas PJ, Bredenoord AJ, Fox M, Gyawali CP, Roman S, Smout AJ, Pandolfino JE; International High Resolution Manometry Working Group. The Chicago Classification of esophageal motility disorders, v3.0. Neurogastroenterol Motil. 2015 Feb;27(2):160–74.
  2. Gyawali CP, Kahrilas PJ, Savarino E, Zerbib F, Mion F, Smout AJPM, Vaezi M, Sifrim D, Fox MR, Vela MF, Tutuian R, Tack J, Bredenoord AJ, Pandolfino J, Roman S. Modern diagnosis of GERD: the Lyon Consensus. Gut. 2018.
  3. Gyawali CP, Roman S, Bredenoord AJ, Fox M, Keller J, Pandolfino JE, Sifrim D, Tatum R, Yadlapati R, Savarino E; International GERD Consensus Working Group. Classification of esophageal motor findings in gastro-esophageal reflux disease: Conclusions from an international consensus group. Neurogastroenterol Motil. 2017 Dec;29(12).