Reflux esophagitis patients exhibit reduced gastric tolerance, impaired slow-wave activity and esophageal dysmotility.

BACKGROUND: Reflux esophagitis (RE) is an endoscopic subtype of gastroesophageal reflux disease (GERD). Although gastric dysfunction is known to contribute to GERD, a comprehensive assessment of gastric motor function specifically in RE patients remains lacking. OBJECTIVE: To comprehensively evaluate gastric motor function in patients with reflux esophagitis (RE) using a multidimensional non-invasive protocol, and to explore the associations between gastric motility abnormalities and esophageal dysmotility. METHODS: Forty RE patients diagnosed by endoscopy and high-resolution manometry (HRM) and 34 healthy controls were enrolled between April 2019 and January 2020 based on feasibility of recruitment during the study period. Gastric tolerance and visceral sensitivity were evaluated using a nutrient drink test combined with a visual analog scale (VAS). Gastric emptying was assessed by gastrointestinal ultrasound, and gastric myoelectrical activity was recorded by electrogastrography (EGG). Esophageal motility was simultaneously evaluated by HRM. RESULTS: Compared with controls, RE patients showed significantly reduced maximum tolerated volume (MTV), higher postprandial VAS scores for fullness, nausea and pain, lower gastric emptying rates at 20 and 30 min postprandially, and a lower percentage of normal postprandial slow waves (all p < 0.05). After normalization to ingested volume (symptom load index), RE patients still exhibited a significantly higher symptom load for fullness and pain at all postprandial time points, and for nausea at 10, 20, and 30 min (all p < 0.01). Heartburn severity was positively correlated with pain score at 0 min postprandial (r = 0.442, p = 0.004), and regurgitation severity was positively correlated with gastric emptying rate at 30 min (r = 0.512, p = 0.001). The 20-min fullness score was negatively correlated with distal contractile integral (DCI) (r = -0.353, p = 0.025). CONCLUSION: RE patients exhibit multiple gastric motility abnormalities, including reduced gastric tolerance, visceral hypersensitivity, delayed gastric emptying, and postprandial gastric dysrhythmia. These gastric dysfunctions are associated with typical RE symptoms and selectively correlate with esophageal contractile indices, suggesting that RE may represent a disorder of upper gastrointestinal motility.