The following is a summary of “Dysphagia Worsens With Increasing Ineffective Swallows Among Patients With Ineffective Esophageal Motility,” published in the August 2023 issue of the Clinical Gastroenterology by Rangan et al.

Ineffective esophageal motility (IEM) is the prevailing motility disorder observed during esophageal high-resolution manometry (HRM), yet individuals exhibiting this condition may not display any symptoms. Hence, researcher’s objective was to ascertain particular HRM observations that can predict symptoms in individuals with IEM. Adult patients (≥18 years) who underwent high-resolution manometry (HRM) between March 2016 and July 2019 were retrospectively assessed and reclassified based on the Chicago Classification 4.0 (CC4.0). Demographic data, HRM metrics, and responses to the gastroesophageal reflux disease Health-Related Quality of Life Questionnaire were collected from individuals with either normal manometry or ineffective esophageal motility.

Researchers assessed the correlation between symptoms of heartburn, regurgitation, and dysphagia concerning high-resolution manometry (HRM) results, including ineffective swallows. Out of a total of 379 patients, 243 (64.1%) exhibited expected manometry results, while 136 (35.9%) displayed symptoms falling within the spectrum of IEM (intestinal motility disorders). Additionally, 73 patients (19.3%) were diagnosed with conclusive IEM based on CC4.0 criteria. The average dysphagia scores were significantly elevated in individuals with conclusive impaired esophageal motility (IEM) compared to those with normal high-resolution manometry (HRM) (2.00 vs. 1.36, P=0.002). Additionally, more individuals with conclusive IEM reported dysphagia impacting their daily activities (21.9% vs. 11.4%, P=0.02). 

The symptoms of gastroesophageal reflux disease (GERD), including heartburn and regurgitation, were similar in both groups. In a multivariable model of patients with inherited metabolic disorders (IEM), the proportion of ineffective swallows was an independent predictor of increased dysphagia burden (β regression coefficient: 0.032, P=0.04). Utilizing the CC4.0 criteria for conclusive inborn errors of metabolism (IEM), a cohort of patients exhibiting more severe dysphagia symptoms is identified. Within this cohort, the proportion of inefficient deglutition was identified as an autonomous prognosticator of the severity of dysphagia. These findings may assist healthcare professionals and individuals in understanding the varied diagnosis of inborn errors of metabolism (IEM).

Source: journals.lww.com/jcge/Abstract/2023/08000/Dysphagia_Worsens_With_Increasing_Ineffective.7.aspx