PPI therapy beneficial to dysphagia patients with pathologic acid exposure
Dysphagic patients with pathologic acid exposure time (AET) and reduced peristaltic vigour may benefit from an adequate proton pump inhibitor (PPI) therapy, with a recent study showing that the drug significantly cuts dysphagia frequency and severity, as well as improves the oesophageal peristaltic force.
The study included 37 nonerosive reflux disease (NERD) patients with dysphagia only (group 1), 52 patients with both dysphagia and typical gastroesophageal reflux disease (GERD) symptoms (group 2), and 44 NERD patients without dysphagia. Assessments were performed using symptom scores, high-resolution manometry (HRM) combined with impedance, and 24 hours impedance-pH monitoring.
Pathologic AET was present in 40 percent of patients in group 1, 52 percent in group 2 and 43 percent in the NERD-only group. The difference among the patient groups was not significant.
Group 1 patients with a pathologic AET particularly had a significantly lower mean distal contractile integral (DCI). Moreover, individual DCI was significantly correlated with total bolus transit time values.
Of the patients in group 1, 22 (including 11 with pathologic AET) received treatment with esomeprazole 40 mg oid for 4 weeks. In the subgroup of patients with pathologic AET, the mean dysphagia score dropped significantly from 7.5 pretherapy to 4 during PPI therapy (p<0.01), whereas the mean DCI value increased notably.
In light of the present data, stress, anxiety and hypervigilance might be significant for the development of oesophageal hypersensitivity in nonobstructive dysphagia patients with normal AET, researchers said, adding that the role of oesophageal motility and of bolus clearance in dysphagia pathophysiology needs to be further elucidated.
Nonobstructive dysphagia is characterized by a sensation of difficult bolus transit in absence of a detectable obstruction of the oesophageal lumen at endoscopy or radiology. Bolus passage through the oesophagus is mainly influenced by the balance between the peristaltic propulsive force and the outflow resistance across the esophagogastric junction. [J Gastroenterol Hepatol 2012;27:873–881]
HRM is considered the gold standard for the evaluation of patients with nonobstructive dysphagia. Still, it should be noted that a large majority of patients presenting with the symptom of difficulty in swallowing do not present pathologic HRM and videofluoroscopy findings. [Neurogastroenterol Motil 2012;24:57–65; Am J Gastroenterol 2005;100:2624–2632]