Division of Gastroenterology, Washington University School of Medicine, St. Louis, Missouri.
Barts and The London School of Medicine and Dentistry Queen Mary, University of London, London, UK.
Neurogastroenterol Motil. 2019 Sep;31(9):e13584. doi: 10.1111/nmo.13584. Epub 2019 Apr 11.
Ineffective esophageal motility (IEM) is a heterogenous minor motility disorder diagnosed when ≥50% ineffective peristaltic sequences (distal contractile integral <450 mm Hg cm s) coexist with normal lower esophageal sphincter relaxation (integrated relaxation pressure < upper limit of normal) on esophageal high-resolution manometry (HRM). Ineffective esophageal motility is not consistently related to disease states or symptoms and may be seen in asymptomatic healthy individuals.
A 1-day symposium of esophageal experts reviewed existing literature on IEM, and this review represents the conclusions from the symposium. Severe IEM (>70% ineffective sequences) is associated with higher esophageal reflux burden, particularly while supine, but milder variants do not progress over time or consistently impact quality of life. Ineffective esophageal motility can be further characterized using provocative maneuvers during HRM, especially multiple rapid swallows, where augmentation of smooth muscle contraction defines contraction reserve. The presence of contraction reserve may predict better prognosis, lesser reflux burden and confidence in a standard fundoplication for surgical management of reflux. Other provocative maneuvers (solid swallows, standardized test meal, rapid drink challenge) are useful to characterize bolus transit in IEM. No effective pharmacotherapy exists, and current managements target symptoms and concurrent reflux. Novel testing modalities (baseline and mucosal impedance, functional lumen imaging probe) show promise in elucidating pathophysiology and stratifying IEM phenotypes. Specific prokinetic agents targeting esophageal smooth muscle need to be developed for precision management.
无效食管动力（IEM）是一种异质性的次要运动障碍，当≥50%无效蠕动序列（远端收缩积分<450mmHg·cm·s）与正常食管下括约肌松弛（整合松弛压力<正常上限）共存时，通过食管高分辨率测压（HRM）诊断。无效食管动力与疾病状态或症状并不一致相关，也可见于无症状的健康个体。
食管专家为期 1 天的研讨会回顾了 IEM 的现有文献，本综述代表了研讨会的结论。严重的 IEM（>70%无效序列）与更高的食管反流负担相关，尤其是仰卧位时，但较轻的变异不会随时间进展或一致影响生活质量。通过 HRM 期间的激发性操作（尤其是多次快速吞咽）可以进一步描述无效食管动力，其中平滑肌收缩的增强定义收缩储备。收缩储备的存在可能预示着更好的预后、更少的反流负担以及对标准胃底折叠术治疗反流的信心。其他激发性操作（固体吞咽、标准化测试餐、快速饮料挑战）有助于描述 IEM 中的食团转运。目前尚无有效的药物治疗方法，当前的治疗方法针对症状和并发的反流。新的测试方式（基线和黏膜阻抗、功能腔成像探头）在阐明病理生理学和分层 IEM 表型方面显示出前景。需要开发针对食管平滑肌的特定促动力药物来进行精确管理。
