Factors affecting esophageal motility in gastroesophageal reflux disease.

BACKGROUND There are conflicting data concerning the effect of gastroesophageal reflux disease (GERD) on esophageal motor function. HYPOTHESIS Duration of GERD might affect severity of symptoms, grade of esophageal mucosal injury, and esophageal motor behavior. DESIGN Retrospective study of a defined cohort. SETTINGS Two referral centers, one of them academic, for esophageal gastrointestinal motility disorders. PATIENTS One hundred forty-seven patients with documented GERD. MAIN OUTCOME MEASURES Symptoms, grade of mucosal injury on esophagoscopy, esophageal manometry, ambulatory esophageal pH monitoring, and esophagogram. RESULTS Patients with GERD had significantly decreased lower esophageal sphincter resting pressure (P =.02), lower amplitude of esophageal peristalsis at all levels of measurement (P<.001), and more delayed esophageal transit (P =.007) compared with control subjects. Patients with dysphagia, severe esophagitis, and Barrett esophagus presented with a longer history of the disease, significantly worse esophageal motor function (P<.01), and more prolonged esophageal transit than patients without the above features of the disease. Impairment of esophageal peristalsis and lower esophageal sphincter resting pressure were significantly inversely related to the duration of the disease (P<.001). Also, delay of esophageal transit was significantly related to the duration of the disease (P =.002) and inversely related to the amplitude of esophageal peristalsis (P<.001). Unlike the manometric variables, the extent of reflux, as assessed by ambulatory 24-hour esophageal pH monitoring, was not related to the duration of the disease. CONCLUSION A long history of GERD is more commonly associated with presence of dysphagia, delayed esophageal transit, severe esophagitis, presence of Barrett esophagus, and impaired esophageal motility.