Comentários: Este trabalho demonstrou que pacientes com esôfago de Barrett têm comprometimento acentuado da contratilidade do esôfago.
Impaired motility in Barrett’s esophagus: A study using high-resolution manometry with physiologic challenge
S Sanagapalli, A Emmanuel, R Leong, S Kerr, L Lovat, R Haidry, M Banks, D Graham, A. Raeburn, N Zarate-Lopez, R Sweis GI Physiology Unit, University College London Hospital, London, UK
First published: 15 March 2018 https://doi.org/10.1111/nmo.13330
Background: Esophageal dysmotility may predispose to Barrett’s esophagus (BE).
We hypothesized that high-resolution manometry (HRM) performed with additional
physiologic challenge would better delineate dysmotility in BE.
Methods: Included patients had typical reflux symptoms and underwent endoscopy,
HRM with single water swallows and adjunctive testing with solids and rapid drink
challenge (RDC) before ambulatory pH-impedancemonitoring. BE and endoscopy-negative
reflux disease (ENRD) subjects were compared against functional heartburn patient-controls
(FHC). Primary outcome was incidence of HRM contractile abnormalities
with standard and adjunctive swallows. Secondary outcomes included clearance
measures and symptom association on pH-impedance.
Key Results: Seventy-eight patients (BE 25, ENRD 27, FHC 26) were included. Water
swallow contractility was reduced in both BE (median DCI 87 mm Hg/cm/s) and
ENRD (442 mm Hg/cm/s) compared to FHC (602 mm Hg/cm/s; P < .001 and .04, respectively).
With the challenge of solid swallows and RDC, these parameters improved
in ENRD (solids = 1732 mm Hg/cm/s), becoming similar to FHC (1242 mm Hg/
cm/s; P = .93), whereas abnormalities persisted in BE (818 mm Hg/cm/s; P < .01 c.f.
FHC). In BE and ENRD, reflux events (67 vs 57 events/24 hour) and symptom frequency
were similar; yet symptom correlation was significantly better in ENRD compared
to BE, which was comparable to FHC (symptom index 30% vs 4% vs 0%,
respectively). Furthermore, bolus clearance and exposure times were more pronounced
in BE (P < .01).
Conclusions & Inferences: Reduced contractile effectiveness persisted in BE with
the more representative esophageal challenge of swallowing solids and free drinking;
while in ENRD and FHC peristalsis usually improved, demonstrating peristaltic reserve.
Furthermore, symptom association and refluxate clearance were reduced in BE. These factors may underlie BE pathogenesis.