INEFFECTIVE ESOPHAGEAL MOTILITY (IEM) - THE PRIMARY FINDING IN PATIENTS WITH NONSPECIFIC ESOPHAGEAL MOTILITY DISORDER

Nonspecific esophageal motility disorder (NEMD) is a vague category us ed to include patients with poorly defined esophageal contraction abno rmalities, The criteria include ''ineffective'' contraction waves, ie, peristaltic waves that are either of low amplitude or are not transmi tted, The aim of this study was to identify the prevalence of ineffect ive esophageal motility (IEM) found during manometry testing and to ev aluate esophageal acid exposure and esophageal acid clearance (EAC) in patients with IEM compared to those with other motility findings, We analyzed esophageal manometric tracings from 600 consecutive patients undergoing manometry in our laboratory following a specific protocol f rom April 1992 through October 1994 to identify the frequency of ineff ective contractions and the percentages of other motility abnormalitie s present in patients meeting criteria for NEMD, Comparison of acid ex posure and EAC was made with 150 patients who also had both esophageal manometry and pH-metry over the same time period, Sixty-one of 600 pa tients (10%) met the diagnostic criteria for NEMD, Sixty of 61 (98%) o f these patients had IEM, defined by at least 30% ineffective contract ions out of 10 wet swallows, Thirty-five of these patients also underw ent ambulatory esophageal pH monitoring, Patients with IEM demonstrate d significant increases in both recumbent median percentage of time of pH < 4 (4.5%) and median distal EAC (4.2 min/episode) compared to tho se with normal motility (0.2%, 1 min/episode), diffuse esophageal spas m (0%, 0.6 min/episode), hypertensive LES (0%, 1.8 min/episode), and n utcracker esophagus (0.4% 1.6 min/episode). Recumbent acid exposure in IEM did not differ significantly from that in patients with systemic scleroderma (SSc) for either variable (5.4%, 4.2 min/episode), We prop ose that IEM is a more appropriate term and should replace NEMD, givin g it a more specific manometric identity, IEM patients demonstrate a d istinctive recumbent reflux pattern, similar to that seen in patients with SSc. This finding indicates that there is an association between IEM and recumbent GER, Whether IEM is the cause or the effect of incre ased esophageal acid exposure remains to be determined.