Ineffective oesophageal motility (IOM) is a common swallowing abnormality characterised by low-amplitude contractile sequences in the lower oesophagus. These ineffective sequences include low amplitude but progressive, low-amplitude simultaneous, and non-transmitted contractile patterns. It is not known whether specific symptoms experienced by IOM patients, such as heartburn, dysphagia (sensation of swallowing difficulty) and chest pain, are associated with one of these three contractile patterns. Also, although gastro-oesophageal reflux disease is common in IOM patients, it is not known if patients with a particular IOM pattern experience the most reflux.
A research article to be published on 21 June 2008, in the World Journal of Gastroenterology addressed this question. The research team led by John E Kellow from Royal North Shore Hospital of Australia investigated relationships between the symptoms experienced by 100 patients with IOM and their oesophageal function, assessed by manometry (pressure) and ambulatory pH (reflux) testing.
It was found that patients whose ineffective swallows featured mainly simultaneous sequences experienced less heartburn but more dysphagia than those with progressive but weak swallow patterns. The former group differed similarly from a group of 100 age- and gender-matched patients with normal oesophageal function. Groups did not differ in reflux characteristics.
The novel finding of this study is that patients with different subsets of ineffective contractile patterns exhibit different symptom profiles. This raises the possibility of different pathophysiological mechanisms, hence different treatment approaches, in selected IOM patients.