Demographic and symptomatic predictors of incomplete bolus transit in patients with ineffective oesophageal motility.

Introduction: Ineffective oesophageal motility (IOM) describes a non-specific manometric pattern of peristaltic failure. It is a common abnormality, affecting as many as 61% of patients undergoing manometry for query oesophageal motility disorders. IOM is also known as hypotensive (<30mmHg) oesophageal contractions; bolus clearance is impaired by low amplitude and ineffective pressure waves. Oesophageal contractions with ≥30mmHg amplitudes are required to effectively propel food.4 IOM is defined as ineffective or non-transmitted, failed contractions (<30mmHg) occurring in at least 20% of swallows.

Methods: A retrospective chart review of patients referred to a regional gut motility centre in Canada who were then diagnosed with IOM was performed. Multiple linear regression analysis was used to determine demographic predictors of incomplete bolus clearance, including gender, age and primary complaint.

Results: A total of 230 patients (130 females, 100 males; mean age, 51.7 years; range, 18-82.3 years) with a diagnosis of IOM were included. Primary presenting complaints included dysphagia (33.9%), and heartburn and reflux (33%). Decreasing proportions of peristaltic contractions correlated significantly with decreased bolus transit. Conversely, higher intrabolus pressure correlated significantly with incomplete bolus transit. Intrabolus pressure serves as an indicator of outflow obstruction, and forces resisting peristalsis and incomplete bolus transport.5 Gender was not significant but increasing age was associated with less incomplete bolus transit.

Conclusion: Dysphagia was the most common symptom reported by patients with IOM, followed by heartburn and reflux. Other demographic factors should be evaluated for their effect on bolus transit.