Esophageal symptom burden remains high and associates with failed swallows after five years in patients with ineffective esophageal motility

Purpose: Ineffective esophageal motility (IEM) is a motor disorder of the esophagus diagnosed by high-resolution esophageal manometry (HRM) and associated with symptoms of gastroesophageal reflux disease (GERD) and dysphagia; however, the long-term significance is unclear. The goal of this study was to assess esophageal symptoms in patients with IEM diagnosed 5 or more years earlier. Methods: Adult patients diagnosed with IEM ≥5 years earlier by HRM were included and sent validated esophageal symptom questionnaires including the Gastroesophageal Reflux Disease Questionnaire (GerdQ), Gastroesophageal Reflux Disease Health-related Quality of Life (GERD-HRQL) Questionnaire, and the Brief Esophageal Dysphagia Questionnaire (BEDQ). Symptom scores were assessed by esophageal motor function including the number of intact, failed, and ineffective swallows. Statistical analysis was performed using the Fisher’s exact test, Mann-Whitney U-test, and Spearman correlation coefficients. Results: Forty-seven patients were included and 26 (55.3%) were positive for GERD by the GerdQ score, 21 (44.7%) by GERD-HQRL, and 35 (74.5%) for dysphagia by BEDQ score. Presence of ≥7 swallows with failed peristalsis was associated with a greater GerdQ score (9 vs. 7, p=0.029) and dissatisfaction with current symptoms; ≥8 failed swallows was associated with worse dysphagia by the BEDQ score (21.5 vs. 12, p=0.037). Number of failed swallows correlated with GerdQ (ρ=0.46, p=0.0011) and GERD-HRQL scores (ρ=0.43, p=0.0025). Conclusion: In this cross-sectional survey study of patients with IEM diagnosed 5 or more years earlier, at least 45% reported GERD symptoms, 75% dysphagia symptoms; the number of swallows with failed peristalsis was associated with worse GERD and dysphagia symptoms.