Ineffective esophageal motility (IEM) is a hypomotility disorder with decreased contraction vigor and normally relaxing lower esophageal sphincter. Although IEM has been associated with poor esophageal clearance and gastroesophageal reflux, it is also seen in asymptomatic subjects and is often of unclear clinical significance. The Chicago classification version 4.0 updated the diagnostic threshold to require >70% weak or fragmented swallows or ≥50% failed swallows for a conclusive diagnosis of IEM. Provocation testing are recommended in borderline cases to assess clinical relevance. Prospective trials are needed to further refine the diagnostic criteria, understand the pathophysiology, and develop an effective treatment for IEM.
KahrilasPJDoddsWJHoganWJ.Effect of peristaltic dysfunction on esophageal volume clearance. Gastroenterology. 1988;94(1):73-80.
2.
BlonskiWVelaMSafderAHilaACastellDO.Revised criterion for diagnosis of ineffective esophageal motility is associated with more frequent dysphagia and greater bolus transit abnormalities. Am J Gastroenterol. 2008;103(3):699-704.
3.
ConchilloJMNguyenNQSamsomMHollowayRHSmoutAJ.Multichannel intraluminal impedance monitoring in the evaluation of patients with non-obstructive dysphagia. Am J Gastroenterol. 2005;100(12):2624-2632.
4.
TutuianRCastellDO.Combined multichannel intraluminal impedance and manometry clarifies esophageal function abnormalities: study in 350 patients. Am J Gastroenterol. 2004;99(6):1011-1019.
5.
XiaoYKahrilasPJKwasnyMJ, et al. High-resolution manometry correlates of ineffective esophageal motility. Am J Gastroenterol. 2012;107(11):1647-1654.
6.
KahrilasPJBredenoordAJFoxM, et al. The Chicago Classification of esophageal motility disorders, v3.0. Neurogastroenterol Motil. 2015;27(2):160-174.
ShetlerKPBikhtiiSTriadafilopoulosG.Ineffective esophageal motility: clinical, manometric, and outcome characteristics in patients with and without abnormal esophageal acid exposure. Dis Esophagus. 2017;30(6):1-8.
9.
ZerbibFMarinICisternasD, et al. Ineffective esophageal motility and bolus clearance. A study with combined high-resolution manometry and impedance in asymptomatic controls and patients. Neurogastroenterol Motil. 2020;32(9):e13876.
10.
JainABakerJRChenJW.In ineffective esophageal motility, failed swallows are more functionally relevant than weak swallows. Neurogastroenterol Motil. 2018;30(6):e13297.
11.
RengarajanABolkhirAGorPWangDMunigalaSGyawaliCP.Esophagogastric junction and esophageal body contraction metrics on high-resolution manometry predict esophageal acid burden. Neurogastroenterol Motil. 2018;30(5):e13267.
12.
ReddyCABakerJRLauJChenJW.High-resolution manometry diagnosis of ineffective esophageal motility is associated with higher reflux burden. Dig Dis Sci. 2019;64(8):2199-2205.
13.
KasamatsuSMatsumuraTOhtaY, et al. The effect of ineffective esophageal motility on gastroesophageal reflux disease. Digestion. 2017;95(3):221-228.
14.
DienerUPattiMGMolenaDFisichellaPMWayLW.Esophageal dysmotility and gastroesophageal reflux disease. J Gastrointest Surg. 2001;5(3):260-265.
15.
LeeJAnggiansahAAnggiansahRYoungAWongTFoxM.Effects of age on the gastroesophageal junction, esophageal motility, and reflux disease. Clin Gastroenterol Hepatol. 2007;5(12):1392-1398.
16.
TriadafilopoulosGTandonAShetlerKPClarkeJ.Clinical and pH study characteristics in reflux patients with and without ineffective oesophageal motility (IEM). BMJ Open Gastroenterol. 2016;3(1):e000126.
17.
RibolsiMBalestrieriPEmerenzianiSGuarinoMPCicalaM.Weak peristalsis with large breaks is associated with higher acid exposure and delayed reflux clearance in the supine position in GERD patients. Am J Gastroenterol. 2014;109(1):46-51.
18.
DaoHVMatsumuraTKanekoT, et al. Impact of ineffective esophageal motility on chemical clearance in patients with gastroesophageal reflux symptoms. Dis Esophagus. 2020;33(9):doaa026.
19.
LeiWYGyawaliCPChangWC, et al. Application of a novel straight leg raise test during high-resolution manometry can predict esophageal contractile reserve in patients with gastroesophageal reflux disease. Neurogastroenterol Motil. 2021;33(3):e13996.
20.
BolandKAbdul-HusseinMTutuianRCastellDO.Characteristics of consecutive esophageal motility diagnoses after a decade of change. J Clin Gastroenterol. 2016;50(4):301-306.
21.
HollensteinMThwaitesPBütikoferS, et al. Pharyngeal swallowing and oesophageal motility during a solid meal test: a prospective study in healthy volunteers and patients with major motility disorders. Lancet Gastroenterol Hepatol. 2017;2(9):644-653.
RogersBDRengarajanAMauroA, et al. Fragmented and failed swallows on esophageal high-resolution manometry associate with abnormal reflux burden better than weak swallows. Neurogastroenterol Motil. 2020;32(2):e13736.
24.
BulsiewiczWJKahrilasPJKwiatekMAGhoshSKMeekAPandolfinoJE.Esophageal pressure topography criteria indicative of incomplete bolus clearance: a study using high-resolution impedance manometry. Am J Gastroenterol. 2009;104(11):2721-2728.
25.
RogersBDCisternasDRengarajanA, et al. Breaks in peristaltic integrity predict abnormal esophageal bolus clearance better than contraction vigor or residual pressure at the esophagogastric junction. Neurogastroenterol Motil. Published online March 27, 2021. doi:10.1111/nmo.14141
26.
GyawaliCPZerbibFBhatiaS, et al. Chicago Classification update (V4.0): technical review on diagnostic criteria for ineffective esophageal motility and absent contractility. Neurogastroenterol Motil. 2021;33:e14134.
27.
ShakerAStoikesNDrapekinJKushnirVBruntLMGyawaliCP.Multiple rapid swallow responses during esophageal high-resolution manometry reflect esophageal body peristaltic reserve. Am J Gastroenterol. 2013;108(11):1706-1712.
28.
HasakSBruntLMWangDGyawaliCP.Clinical characteristics and outcomes of patients with postfundoplication dysphagia. Clin Gastroenterol Hepatol. 2019;17(10):1982-1990.
29.
MelloMDShriverARLiYPatelAGyawaliCP.Ineffective esophageal motility phenotypes following fundoplication in gastroesophageal reflux disease. Neurogastroenterol Motil. 2016;28(2):292-298.
30.
QuaderFRogersBSieversT, et al. Contraction reserve with ineffective esophageal motility on esophageal high-resolution manometry is associated with lower acid exposure times compared with absent contraction reserve. Am J Gastroenterol. 2020;115(12):1981-1988.
31.
MinYWShinISonHJRheePL.Multiple rapid swallow maneuver enhances the clinical utility of high-resolution manometry in patients showing ineffective esophageal motility. Medicine. 2015;94(40):e1669.
32.
ZerbibFLunaDMarinISerraJ.The added value of symptom analysis during a rapid drink challenge in high-resolution esophageal manometry. Neurogastroenterol Motil. 2021;33(4):e14008.
33.
AngDHollensteinMMisselwitzB, et al. Rapid drink challenge in high-resolution manometry: an adjunctive test for detection of esophageal motility disorders. Neurogastroenterol Motil. 2017;29(1):10.1111/nmo.12902.
34.
PondsFAOorsJMSmoutAJPMBredenoordAJ.Rapid drinking challenge during high-resolution manometry is complementary to timed barium esophagogram for diagnosis and follow-up of achalasia. Neurogastroenterol Motil. 2018;30(11):e13404.
35.
MarinISerraJ.Patterns of esophageal pressure responses to a rapid drink challenge test in patients with esophageal motility disorders. Neurogastroenterol Motil. 2016;28(4):543-553.
36.
WoodlandPGabieta-SonmezSArgueroJ, et al. 200 mL rapid drink challenge during high-resolution manometry best predicts objective Esophagogastric junction obstruction and correlates with symptom severity. J Neurogastroenterol Motil. 2018;24(3):410-414.
37.
BiasuttoDMionFGarrosARomanS.Rapid drink challenge test during esophageal high resolution manometry in patients with esophago-gastric junction outflow obstruction. Neurogastroenterol Motil. 2018;30(6):e13293.
38.
LaliberteASLouieBEWilshireCLFarivarASBogradAJAyeRW.Ineffective esophageal motility is not a contraindication to total fundoplication. Surg Endosc. 2021;35(8):4811-4816.
39.
AddoAGeorgePZahiriHRParkA.Patients with ineffective esophageal motility benefit from laparoscopic antireflux surgery. Surg Endosc. 2021;35(8):4459-4468.
