Esophageal Dysmotility in Idiopathic Pulmonary Fibrosis

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To understand the inter-relationships between esophageal motility, lung mechanics and reflux (particularly proximal reflux – a prerequisite of aspiration), and pulmonary function in patients with IPF, 35 patients were prospectively recruited with IPF, aged 53 to 75 years and 27 of whom were men. These underwent highresolution impedance manometry and 24hour pH-impedance, together with pulmonary function assessment.

A total of 22 patients (63%), exhibited dysmotility and 16 (73%) exhibited ineffective esophageal motility (IEM); 6 (27%) exhibited esophagogastric junction outflow obstruction.

Patients with IEM have more severe pulmonary disease and more proximal reflux than patients with normal motility. In patients with IEM, intrathoracic pressure adversely correlated with the number of proximal events. Surprisingly, inspiratory lower esophageal sphincter pressure (LESP) positively correlated with the percentage of reflux events reaching the proximal esophagus, whereas in patients with normal motility, it inversely correlated with a bolus exposure time and number of proximal events.

Percentage forced vital capacity in patients with IEM inversely correlated with inspiratory LESP and positively correlated with intrathoracic pressure. 

The study demonstrated that pulmonary function is worse in patients with IEM, which is associated with more proximal reflux events, the latter correlating with lower intrathoracic pressures and higher LESPs.

Cheah, R., Chirnaksorn, S., Abdelrahim, A., et al.  “The Perils and Pitfalls of Esophageal Dysmotility in Idiopathic Pulmonary Fibrosis.” American Journal of Gastroenterology, 2021; Vol. 116, pp. 1189-1200.

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