Complex assessment of esophageal acidification and motor function in patients with Barrett's esophagus on antisecretory therapy

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Abstract

Aim. To determine predictors of insufficient effectiveness of proton pump inhibitors based on the parameters of 24-hours pH-impedance and features of motor function of the esophagus in patients with Barrett's esophagus.

Materials and methods. 17 patients with histologically verified Barrett's esophagus undergoing acid-suppressive therapy were examined. All patients underwent 24-hours pH-impedance and high-resolution esophageal manometry.

Results. According to daily pH-impedance, group 1 consisted of 11 patients with an adequate response to antisecretory therapy, group 2 – 6 patients with insufficient effectiveness of antisecretory therapy, 5 of whom had no clinical manifestations. The total number of reflux averaged 52 and 91, respectively, in groups 1 and 2. The average number of acid reflux in group 1 was 4.36, in group 2 – 40.5. The average number of non-acid reflux prevailed in patients of group 2, averaging 58, compared with group 1, where the average was 47. According to the results of high-resolution esophageal manometry, when assessing the structure and function of the esophageal-gastric junction, violations were detected in 6 out of 17 patients. Disorders of the motor function of the thoracic esophagus were detected in 10 out of 17 patients. The tone of the lower esophageal sphincter in group 1 patients was significantly higher in comparison with patients in group 2.

Conclusion. A number of patients with Barrett's esophagus have insufficient effectiveness of antisecretory therapy, which may not manifest itself clinically and thereby increase the risk of progression. There was a tendency to more frequent motor disorders in the group with insufficient effectiveness of antisecretory therapy, as well as significantly lower tone of the lower esophageal sphincter, which may be a potential predictor of suboptimal effectiveness of antisecretory therapy.

About the authors

Igor V. Maev

Yevdokimov Moscow State University of Medicine and Dentistry

Email: maslovaalena@mail.ru
ORCID iD: 0000-0001-6114-564X

акад. РАН, д-р мед. наук, проф., зав. каф. пропедевтики внутренних болезней и гастроэнтерологии

Russian Federation, Moscow

Elena V. Barkalova

Yevdokimov Moscow State University of Medicine and Dentistry

Author for correspondence.
Email: maslovaalena@mail.ru
ORCID iD: 0000-0001-5882-9397

ассистент каф. пропедевтики внутренних болезней и гастроэнтерологии, рук. лаб. функциональных методов исследования в гастроэнтерологии

Russian Federation, Moscow

Dmitry N. Andreev

Yevdokimov Moscow State University of Medicine and Dentistry

Email: maslovaalena@mail.ru
ORCID iD: 0000-0002-4007-7112

канд. мед. наук, доц. каф. пропедевтики внутренних болезней и гастроэнтерологии, науч. сотр. лаб. функциональных методов исследования в гастроэнтерологии

Russian Federation, Moscow

Mariia A. Ovsepian

Yevdokimov Moscow State University of Medicine and Dentistry

Email: maslovaalena@mail.ru
ORCID iD: 0000-0003-4511-6704

ст. лаб. каф. пропедевтики внутренних болезней и гастроэнтерологии, науч. сотр. лаб. функциональных методов исследования в гастроэнтерологии

Russian Federation, Moscow

Petimat R. Movtaeva

Yevdokimov Moscow State University of Medicine and Dentistry

Email: maslovaalena@mail.ru
ORCID iD: 0000-0002-2716-625X

соискатель каф. пропедевтики внутренних болезней и гастроэнтерологии

Russian Federation, Moscow

Oleg V. Zayratyants

Yevdokimov Moscow State University of Medicine and Dentistry

Email: maslovaalena@mail.ru
ORCID iD: 0000-0003-3606-3823

д-р мед. наук, проф., зав. каф. патологической анатомии

Russian Federation, Moscow

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Supplementary files

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2. Fig 1. Dynamics of frequency and mortality of esophageal adenocarcinoma [14].

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3. Fig. 2. Comparative data on the assessment of total time with pH<4 in the esophagus.

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4. Fig. 3. General view of the 24-hours pH-impedance. Ineffective acid-suppressive therapy in patient with BE.

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5. Fig. 4. Comparative data on the assessment of the number of acid reflux per day.

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6. Fig. 5. Correlation of the amount of acid reflux with the time of acidification of the esophagus (pH<4).

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7. Fig. 6. High-resolution manometry. Esophago-gastric junction (EGJ): a – the normal structure of the EGJ. The EGJ is represented by a single pressure zone, including the LES and DC; b – violation of the structure of the EGJ. EGJ is represented by two pressure zones: the upper one is the pressure of the LES, the lower one is the pressure of the DC – a hiatus hernia; c – hypotension of the LES. The LES resting pressure is 4 mmHg (norm 10–45 mmHg).

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8. Fig. 7. High-resolution manometry. Motility of the thoracic esophagus: a – normal motility: DCI – 2769 mmHg × cm × sec (norm 450–8000 mmHg × cm × sec); b – ineffective motility: DCI – 360 mmHg × cm × sec (norm 450–8000 mmHg × cm × sec) – weak peristalsis; c – absent contractility: DCI – 0 mmHg × cm × sec (norm 450–8000 mmHg × cm × sec).

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9. Fig. 8. Comparative data of the tone of the lower esophageal sphincter in the studied groups.

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