TY - JOUR
T1 - Esophagogastric junction contractility for clinical assessment in patients with GERD
T2 - A real added value?
AU - Tolone, S.
AU - De Bortoli, N.
AU - Marabotto, E.
AU - de Cassan, C.
AU - Bodini, G.
AU - Roman, S.
AU - Furnari, M.
AU - Savarino, V.
AU - Docimo, L.
AU - Savarino, E.
PY - 2015/10/1
Y1 - 2015/10/1
N2 - Background: The role of esophagogastric junction contractile integral (EGJ-CI) as assessed by high-resolution manometry (HRM) is unclear. We aimed to correlate the EGJ-CI with impedance-pH findings in gastro-esophageal reflux disease (GERD) patients. Methods: Consecutive patients with GERD symptoms were enrolled. All patients underwent upper endoscopy, HRM, and impedance-pH testing. The EGJ-CI was calculated using the distal contractile integral tool box during three consecutive respiratory cycles. The value was then divided by the duration of these cycles. A value below 13 was considered as a defective EGJ-CI. We also assessed EGJ morphology, esophageal acid exposure time (AET), number of reflux episodes (NRE), and symptom association analysis (SAA). A positive impedance-pH monitoring was considered in case of abnormal AET and/or NRE and/or positive SAA. Key Results: Among 130 patients we enrolled, 91 had GERD (abnormal AET and/or elevated NRE and/or positive SAA) and 39 had functional heartburn (FH) (negative endoscopy, normal AET, normal NRE, and negative SAA). The GERD patients had a lower median value of EGJ-CI (11 [3.1-20.7] vs 22 [9.9-41], p <0.02) compared to FH patients. Patients with a defective EGJ-CI had, more frequently, a positive impedance-pH monitoring or esophageal mucosal lesions at endoscopy (p <0.05 and p <0.05, respectively) than patients with a normal EGJ-CI. An EGJ-CI cut-off value of 5 mmHg cm yielded the optimal performance in identifying GERD at impedance-pH (sensitivity 89%-specificity 63%). Conclusions & Inferences: A defective EGJ-CI at HRM is clearly associated with evidence of GERD at impedance-pH monitoring. Evaluating EGJ-CI may be useful to predict an abnormal impedance-pH testing. Esophagogastric junction (EGJ) plays an important role in defense mechanisms against reflux. Defining EGJ vigor with high-resolution manometry (HRM) may be useful to predict an abnormal impedance-pH testing in reflux disease. This study aims to establish a correlation between EGJ-contractile integral (EGJ-CI) and different reflux parameters, detected during impedance-pH monitoring in GERD patients. Esophagogastric junction contractile integral is calculated at HRM enclosing the upper and lower margins of the EGJ in a DCI toolbox, during three consecutive respiratory cycles and referenced to gastric pressure. The value computed with the DCI tool in mmHg*s*cm is then divided by the duration of the three respiratory cycles (in seconds) yielding EGJ-CI units of mmHg*cm. The value below 13 is established in a series of normal volunteers as a defective EGJ-CI. Reflux parameters determined at impedance-pH monitoring are total number of reflux, total esophageal acid exposure time (AET), and symptom association. Our findings show that, when a defective EGJ-CI is present, a gradual and significant increase IN reflux can be present.
AB - Background: The role of esophagogastric junction contractile integral (EGJ-CI) as assessed by high-resolution manometry (HRM) is unclear. We aimed to correlate the EGJ-CI with impedance-pH findings in gastro-esophageal reflux disease (GERD) patients. Methods: Consecutive patients with GERD symptoms were enrolled. All patients underwent upper endoscopy, HRM, and impedance-pH testing. The EGJ-CI was calculated using the distal contractile integral tool box during three consecutive respiratory cycles. The value was then divided by the duration of these cycles. A value below 13 was considered as a defective EGJ-CI. We also assessed EGJ morphology, esophageal acid exposure time (AET), number of reflux episodes (NRE), and symptom association analysis (SAA). A positive impedance-pH monitoring was considered in case of abnormal AET and/or NRE and/or positive SAA. Key Results: Among 130 patients we enrolled, 91 had GERD (abnormal AET and/or elevated NRE and/or positive SAA) and 39 had functional heartburn (FH) (negative endoscopy, normal AET, normal NRE, and negative SAA). The GERD patients had a lower median value of EGJ-CI (11 [3.1-20.7] vs 22 [9.9-41], p <0.02) compared to FH patients. Patients with a defective EGJ-CI had, more frequently, a positive impedance-pH monitoring or esophageal mucosal lesions at endoscopy (p <0.05 and p <0.05, respectively) than patients with a normal EGJ-CI. An EGJ-CI cut-off value of 5 mmHg cm yielded the optimal performance in identifying GERD at impedance-pH (sensitivity 89%-specificity 63%). Conclusions & Inferences: A defective EGJ-CI at HRM is clearly associated with evidence of GERD at impedance-pH monitoring. Evaluating EGJ-CI may be useful to predict an abnormal impedance-pH testing. Esophagogastric junction (EGJ) plays an important role in defense mechanisms against reflux. Defining EGJ vigor with high-resolution manometry (HRM) may be useful to predict an abnormal impedance-pH testing in reflux disease. This study aims to establish a correlation between EGJ-contractile integral (EGJ-CI) and different reflux parameters, detected during impedance-pH monitoring in GERD patients. Esophagogastric junction contractile integral is calculated at HRM enclosing the upper and lower margins of the EGJ in a DCI toolbox, during three consecutive respiratory cycles and referenced to gastric pressure. The value computed with the DCI tool in mmHg*s*cm is then divided by the duration of the three respiratory cycles (in seconds) yielding EGJ-CI units of mmHg*cm. The value below 13 is established in a series of normal volunteers as a defective EGJ-CI. Reflux parameters determined at impedance-pH monitoring are total number of reflux, total esophageal acid exposure time (AET), and symptom association. Our findings show that, when a defective EGJ-CI is present, a gradual and significant increase IN reflux can be present.
KW - GERD
KW - EGJ contractile integral
KW - Esophagogastric junction
KW - High-resolution manometry
KW - Impedance-pH monitoring
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U2 - 10.1111/nmo.12638
DO - 10.1111/nmo.12638
M3 - Article
C2 - 26227513
AN - SCOPUS:84942291997
VL - 27
SP - 1423
EP - 1431
JO - Neurogastroenterology and Motility
JF - Neurogastroenterology and Motility
SN - 1350-1925
IS - 10
ER -