Esophageal motility disorders in subjects with esophageal reflux disease but without abnormal reflux, measured by 24h Esophageal pH monitoring

Background: In a high proportion of patients with symptomatic gastroesophag eal reflux disease, 24 h esophageal pH monitoring is normal. Aim: To study esophageal motility in patients with symptomatic gastroesophageal reflux di sease and normal 24 h esophageal pH monitoring. Patients and methods: Fourt een patients (12 women, aged 28 to 74 years old) with esophageal reflux dis ease and normal 24 pH monitoring and 14 asymptomatic controls (8 women, age d 19 to 69 years old), were studied. Symptoms were evaluated using an analo g scale and all subjects underwent a barium meal, upper gastrointestinal en doscopy and a standard esophageal manometry. Results: Lower esophageal sphi ncter was normal in 11 patients, hypotonic in one and displaced to the thor ax in two, Esophageal wave amplitude was lower in patients than in asymptom atic controls (10 to 50 and 13 to 70 mm Hg respectively). The proportion of hypotonic waves was Grade I and II in seven patients, Grade III in three a nd grade IV in four cases. Four patients had a localized aperistalsis (that can be considered normal) and four had more severe forms of aperistalsis, along with severe hypotonia. Conclusions: patients with gastroesophageal re flux disease without alternations in 24 h pH monitoring, have alterations i n esophageal motility (Rev Med Chile 2000; 128: 1237-44).