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      Esophageal Motor Dysfunctions in Gastroesophageal Reflux Disease and Therapeutic Perspectives

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          Abstract

          Gastroesophageal reflux disease (GERD) is a very common disease, and the prevalence in the general population has recently increased. GERD is a chronic relapsing disease associated with motility disorders of the upper gastrointestinal tract. Several factors are implicated in GERD, including hypotensive lower esophageal sphincter, frequent transient lower esophageal sphincter relaxation, esophageal hypersensitivity, reduced resistance of the esophageal mucosa against the refluxed contents, ineffective esophageal motility, abnormal bolus transport, deficits initiating secondary peristalsis, abnormal response to multiple rapid swallowing, and hiatal hernia. One or more of these mechanisms result in the reflux of stomach contents into the esophagus, delayed clearance of the refluxate, and the development of symptoms and/or complications. New techniques, such as 24-hour pH and multichannel intraluminal impedance monitoring, multichannel intraluminal impedance and esophageal manometry, high-resolution manometry, 3-dimensional high-resolution manometry, enoscopic functional luminal imaging probe, and 24-hour dynamic esophageal manometry, provide more information on esophageal motility and have clarified the pathophysiology of GERD. Proton pump inhibitors remain the preferred pharmaceutical option to treat GERD. The ideal target of GERD treatment is to restore esophageal motility and reconstruct the anti-reflux mechanism. This review focuses on current advances in esophageal motor dysfunction in patients with GERD and the influence of these developments on GERD treatment.

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          Most cited references54

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          Asia-Pacific consensus on the management of gastro-oesophageal reflux disease: an update focusing on refractory reflux disease and Barrett's oesophagus.

          Since the publication of the Asia-Pacific consensus on gastro-oesophageal reflux disease in 2008, there has been further scientific advancement in this field. This updated consensus focuses on proton pump inhibitor-refractory reflux disease and Barrett's oesophagus.
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            Multiple rapid swallow responses during esophageal high-resolution manometry reflect esophageal body peristaltic reserve.

            Dysphagia may develop following antireflux surgery as a consequence of poor esophageal peristaltic reserve. We hypothesized that suboptimal contraction response following multiple rapid swallows (MRS) could be associated with chronic transit symptoms following antireflux surgery.
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              Esophagogastric junction distensibility assessed with an endoscopic functional luminal imaging probe (EndoFLIP).

              Increased esophagogastric junction (EGJ) compliance is a key abnormality in GERD leading to increased volumes of reflux. To date, EGJ distensibility has been measured only with investigational barostat-based prototype devices. The aim of the study was to test the endoscopic functional luminal imaging probe (EndoFLIP), a new commercially available technology designed to measure intraluminal distensibility, by assessing the EGJ of GERD patients and controls. Prospective case-control series. Tertiary referral center. Twenty GERD patients and 20 controls studied during a routine esophagogastroduodenoscopy. The EndoFLIP was passed through the endoscopic instrumentation channel and positioned across the EGJ. The EndoFLIP uses impedance planimetry to measure 16 cross-sectional areas (CSA) along with the corresponding intrabag pressure within a 4.6-cm cylindrical segment of a fluid-filled bag. EGJ distensibility was assessed with 10- to 40-mL volume-controlled distentions. In both groups, the least distensible locus at the EGJ was usually at the hiatus. As a group, GERD patients exhibited two- to threefold increased EGJ distensibility compared with controls, particularly at 20- to 30-mL distention volumes, values quantitatively similar to previous measurements with barostat-based devices. The endoscopic estimation of EGJ distensibility, the flap valve grade, correlated poorly with EndoFLIP measurements. Heterogeneity of GERD patients. Measurement of EGJ distensibility with EndoFLIP is feasible during clinical endoscopy. Stratifying GERD patients according to this physiological parameter may facilitate the identification of patient subgroups responsive or unresponsive to medical or surgical treatments. Copyright 2010 American Society for Gastrointestinal Endoscopy. Published by Mosby, Inc. All rights reserved.
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                Author and article information

                Journal
                J Neurogastroenterol Motil
                J Neurogastroenterol Motil
                Journal of Neurogastroenterology and Motility
                Korean Society of Neurogastroenterology and Motility
                2093-0879
                2093-0887
                October 2019
                30 October 2019
                : 25
                : 4
                : 499-507
                Affiliations
                [1 ]Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
                [2 ]Department of Gastroenterology, The First Affiliated Hospital of Xiamen University, Xiamen, Fujian Province, China
                Author notes
                [* ]Correspondence: Xiucai Fang, MD, Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 1# Shuaifuyuan, Dongcheng District, Beijing 100730, China, Tel: +86-10-6915-6892, +86-1343-913-6086, Fax: +86-10-6915-1963, E-mail: fangxiucai2@ 123456aliyun.com
                Article
                jnm-25-499
                10.5056/jnm19081
                6786454
                31587540
                affe894b-fcc7-45c7-842c-470963c5f736
                © 2019 The Korean Society of Neurogastroenterology and Motility

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 10 April 2019
                : 20 July 2019
                Categories
                Review

                Neurology
                esophageal motility disorders,esophagogastric junction,gastroesophageal reflux,manometry,pharmaceutical preparations

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