Habitual rapid food intake and ineffective esophageal motility

Abstract

Aim: To study non-cardiac chest pain (NCCP) in relation to ineffective esophageal motility (IEM) and rapid food intake.

Methods: NCCP patients with a self-reported habit of fast eating underwent esophageal manometry for the diagnosis of IEM. Telephone interviews identified eating habits of additional IEM patients. Comparison of manometric features was done among IEM patients with and without the habit of rapid food intake and healthy controls. A case study investigated the effect of 6-mo gum chewing on restoration of esophageal motility in an IEM patient. The Valsalva maneuver was performed in IEM patients and healthy controls to assess the compliance of the esophagus in response to abdominal pressure increase.

Results: Although most patients diagnosed with NCCP do not exhibit IEM, remarkably, all 12 NCCP patients who were self-reporting fast eaters with a main complaint of chest pain (75.0%) had contraction amplitudes in the mid and distal esophagus that were significantly lower compared with healthy controls [(23.45 mmHg (95%CI: 14.06-32.85) vs 58.80 mmHg (95%CI: 42.56-75.04), P < 0.01 and 28.29 mmHg (95%CI: 21.77-34.81) vs 50.75 mmHg (95%CI: 38.44-63.05), P < 0.01, respectively)]. In 7 normal-eating IEM patients with a main complaint of sensation of obstruction (42.9%), the mid amplitude was smaller than in the controls [30.09 mmHg (95%CI: 19.48-40.70) vs 58.80 mmHg (95%CI: 42.56-75.04), P < 0.05]. There was no statistically significant difference in manometric features between the fast-eating and normal-eating groups. One NCCP patient who self-reported fast eating and was subsequently diagnosed with IEM did not improve with proton-pump inhibition but restored swallow-induced contractions upon 6-mo gum-chewing. The Valsalva maneuver caused a markedly reduced pressure rise in the mid and proximal esophagus in the IEM patients.

Conclusion: Habitual rapid food intake may lead to IEM. A prospective study is needed to validate this hypothesis. Gum-chewing might strengthen weakened esophageal muscles.

Keywords: Esophageal manometry; Ineffective esophageal motility; Non-cardiac chest pain; Rapid food intake; Valsalva maneuver.

Figure 1

Manometric tracings of a fast-eating ineffective esophageal motility patient (A) and a healthy control (B). The numbers (in cm) on the left indicate the distances from the nose to each side-hole on the catheter.

Figure 2

Manometric tracings of swallowing at an interval < 10 s (A, C, E) in comparison with swallowing at the interval of 30 s (B, D, F). The numbers (in cm) on the left indicate the distances from the nose to each side-hole on the catheter. In an ineffective esophageal motility patient who was habitually rapidly eating (A, B), only one peristaltic contraction appeared in response to the second of a pair of wet swallows at the interval of 5 s (A). Similar finding was observed in one healthy control (E, F) whose two wet swallows were almost continuous (E). In another control (C, D), peristalsis was only seen in response to the first of a pair of wet swallows at the interval of 8 s (C).

Figure 3

Effects of the Valsalva maneuver on the esophageal manometric tracings in a patient with ineffective esophageal motility (A) and a healthy control (B). The numbers (in cm) on the left indicate the distances from the nose to each side-hole on the catheter.

Figure 4

Manometric tracings of a fast-eating non-cardiac chest pain patient diagnosed with ineffective esophageal motility before (A) and after (B) 6-mo gum-chewing exercise. The numbers (in cm) on the left indicate the distances from the nose to each side-hole on the catheter.