INEFFECTIVE OESOPHAGEAL MOTILITY IN PATIENTS WITH DYSPHAGIA AND GASTRO-OESOPHAGEAL REFLUX DISEASE

Abstract

Oesophageal hypomotility is prevalent in 30-50% of the patients with GORD and/or dysphagia. Despite advances in diagnosing oesophageal hypomotility, there is no established therapy for this group of patients. I studied the effect of Azithromycin in patients with Ineffective oesophageal motility (IOM). I assessed the value of stimulation tests during oesophageal manometry (multiple rapid swallows, bread swallows and swallows with abdominal compression), in identifying the patients who might benefit from prokinetic treatment with Azithromycin. Effect of stimulation tests in healthy subjects was investigated and normal ranges for oesophageal response to these tests was established. Characteristics of normal proximal oesophageal motility were defined and the role of proximal oesophageal hypomotility in symptomatology of the patients with IOM investigated. Effect of azithromycin on IOM and on the symptoms of these patients were studied in a double blind placebo controlled parallel design study. The predictive value of the stimulation tests in identifying the responders to azithromycin therapy was evaluated. Stimulation tests proved to be effective on inducing stronger motility response in oesophageal body and this effect was reproducible. Weak proximal oesophageal motility in patients with IOM is associated with reflux symptoms presentation. Azithromycin can convert IOM to normal motility in a subgroup of patients. Multiple rapid swallowing as well as swallows with abdominal compression can moderately predict the response to prokinetic therapy with Azithromycin.