Vigor of peristalsis during multiple rapid swallows is inversely correlated with acid exposure time in patients with NERD.

Background Multiple rapid swallowing ( MRS) during high-resolution manometry ( HRM) is increasingly utilized as provocative test to assess esophageal peristaltic reserve. The aim of this study was to evaluate the correlation between MRS response and impedance and pH ( MII-pH) parameters in endoscopy negative heartburn ( ENH) patients. Methods We enrolled consecutive ENH patients, who underwent HRM and MII-pH study, with a selected MII-pH profile: abnormal MII-pH (pH+/ MII+); normal MII-pH (pH−/ MII−). HRM was performed with 10 wet swallows ( WS) and one MRS. Mean distal contractile integral ( DCI) during WS and MRS were calculated. MII-pH parameters including acid exposure time ( AET), reflux events, baseline impedance levels ( BI) and the efficacy of chemical clearance evaluated with the postreflux swallow-induced peristaltic wave ( PSPW) index were measured. Key Results We analyzed 103 patients: 49 MII+/pH+ (27 male), and 54 MII−/pH− (19 male). Mean age was similar between the two groups. As expected, mean AET and number of refluxes were higher in pH+/ MII+ ( p < 0.05). HRM was normal in all selected patients. Mean DCI- WS was similar between two groups ( p = n.s.). Mean DCI- MRS- was higher in MII−/pH− vs MII+/pH+ ( p < 0.05). The increase in DCI- MRS was inversely correlated with AET (−0.699; p < 0.001) and directly correlated with BI values (0.631; p < 0.001) and PSPW index (0.626; p < 0.001). Conclusions & Inferences Following MRS, patients with abnormal impedance-pH test showed suboptimal contraction response as compared with those with normal impedance-pH test. Moreover, MRS response was inversely correlated with AET and directly correlated with BI values and PSPW index. [ABSTRACT FROM AUTHOR]