B0214 - Degree of Ineffective Peristalsis Does Not Affect Frequency of Gastroesophageal Reflux, but May Facilitate More Proximal Reflux Events

Christy Chon, MD¹, Michael S. Smith, MD, MBA^2
1Icahn School of Medicine at Mount Sinai Morningside-West, New York, NY; ²Mount Sinai Morningside and Mount Sinai West Hospitals, New York, NY

Introduction: Chicago Classification v4.0 (CC4) describes more stringent criteria for Ineffective Esophageal Motility (IEM), in order to identify patients with clinically significant dysmotility. IEM is a common finding in patients with gastroesophageal reflux disease (GERD). The aim of this study was to evaluate whether patients meeting CC4 IEM criteria also have more severe reflux, as defined by worse outcomes on 24-hour multichannel intraluminal impedance-pH testing (MII-pH).

Methods: A total of 684 patients undergoing GERD evaluation with MII-pH at a single high-volume center between 2019-22 were identified. Patients were included only if they had a diagnosis of either no CC4 abnormality or IEM based on either Chicago Classification v3.0 (CC3) or CC4. For the analysis, patients were divided into three groups: 50-69.9% ineffective swallows (CC3-only IEM), 70-100% ineffective swallows or at least 50% failed swallows (CC4 IEM), and no CC3/CC4 diagnosis (Controls). Demographic data and MII-pH results were collected and analyzed.

Results: Of 153 patients that met criteria, 29 had CC3-only IEM, 98 had CC4 IEM, and 26 were Controls. Age, gender, body mass index and tobacco/alcohol use were similar among groups. The mean total number of normalized reflux events actually was higher in the CC3-only IEM group (66.9) than for CC4 IEM (49.5) and Controls (51.9), but this was not significant (p=0.61 between all groups, p=0.91 between CC3-only IEM vs CC4 IEM). The mean number of proximal reflux episodes was higher for CC4 IEM patients (18.9) than CC3-only IEM patients (9.3) and Controls (6.3), though this also did not reach significance (p=0.23). Both acid exposure times (AETs) and DeMeester scores were higher in IEM patients compared to controls, but the differences also were not significant.

Discussion: The degree of ineffective peristalsis did not affect the overall number of reflux events seen on MII-pH. This finding is expected, as peristalsis is not thought to be involved in the generation of a reflux event. A trend toward more proximal reflux events in patients meeting CC4 criteria suggests a higher degree of esophageal dysmotility increases the likelihood reflux events are not cleared effectively, and therefore have a greater opportunity to move retrograde. Extended refluxate exposure may predispose to worsened symptoms. Future studies focusing on refluxate exposure times and symptom correlation may provide significant conclusions leading to improved care of these patients with dysmotility.



Disclosures:


Christy Chon, MD¹, Michael S. Smith, MD, MBA². B0214 - Degree of Ineffective Peristalsis Does Not Affect Frequency of Gastroesophageal Reflux, but May Facilitate More Proximal Reflux Events, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.