TY - JOUR
T1 - Fragmented and failed swallows on esophageal high-resolution manometry associate with abnormal reflux burden better than weak swallows
AU - Rogers, Benjamin D.
AU - Rengarajan, Arvind
AU - Mauro, Aurelio
AU - Ghisa, Matteo
AU - De Bortoli, Nicola
AU - Cicala, Michele
AU - Ribolsi, Mentore
AU - Penagini, Roberto
AU - Savarino, Edoardo
AU - Gyawali, C. Prakash P.
PY - 2020
Y1 - 2020
N2 - Background: Association between proportions of hypomotile swallows on esophageal high-resolution manometry (HRM) and esophageal reflux burden remains incompletely understood. We investigated relationships between hypomotility, acid exposure time (AET), and mean nocturnal baseline impedance (MNBI) on ambulatory reflux monitoring. Methods: Clinical data, HRM, and ambulatory pH-impedance studies (performed off acid suppression) from patients with persisting reflux symptoms were reviewed from five international centers. AET (abnormal > 6%) and MNBI (abnormal < 2292 ohms) were extracted from pH-impedance studies. Distal contractile integral (DCI) designated esophageal peristalsis into normal (DCI > 450 mmHg.cm.s), fragmented (DCI > 450 mmHg.cm.s with breaks > 5 cm), weak (DCI 100-450 mmHg.cm.s), and failed (DCI < 100 mm mmHg.cm.s) sequences. Univariate and multivariate analyses were performed to identify motor associations of abnormal reflux burden. Key Results: Of 351 patients (52.1 ± 0.8 years, 67%F), 29.3% had AET > 6% and 61.8% had MNBI < 2292 ohms. On univariate analysis, both fragmented peristalsis and IEM associated with abnormal AET (P ≤.01) and MNBI (P ≤.03); reflux burden was more profound with >70% fragmented as well as ineffective sequences compared to ≤70% for each (P <.05 for each comparison). When weak and failed sequences within IEM were separately analyzed, ≥50% failed sequences predicted abnormal AET (P ≤.009), and ≥50% weak sequences did not (P =.14). On multivariate regression, ≥50% failed sequences predicted abnormal AET (P =.02), and >70% ineffective sequences trended strongly (P =.069); >70% ineffective sequences predicted abnormal MNBI (P =.046), and >70% fragmented sequences trended strongly (P =.076). Conclusions and Inferences: Breaks in esophageal peristaltic integrity seen with fragmented and failed sequences are more relevant to abnormal esophageal acid burden than weak sequences.
AB - Background: Association between proportions of hypomotile swallows on esophageal high-resolution manometry (HRM) and esophageal reflux burden remains incompletely understood. We investigated relationships between hypomotility, acid exposure time (AET), and mean nocturnal baseline impedance (MNBI) on ambulatory reflux monitoring. Methods: Clinical data, HRM, and ambulatory pH-impedance studies (performed off acid suppression) from patients with persisting reflux symptoms were reviewed from five international centers. AET (abnormal > 6%) and MNBI (abnormal < 2292 ohms) were extracted from pH-impedance studies. Distal contractile integral (DCI) designated esophageal peristalsis into normal (DCI > 450 mmHg.cm.s), fragmented (DCI > 450 mmHg.cm.s with breaks > 5 cm), weak (DCI 100-450 mmHg.cm.s), and failed (DCI < 100 mm mmHg.cm.s) sequences. Univariate and multivariate analyses were performed to identify motor associations of abnormal reflux burden. Key Results: Of 351 patients (52.1 ± 0.8 years, 67%F), 29.3% had AET > 6% and 61.8% had MNBI < 2292 ohms. On univariate analysis, both fragmented peristalsis and IEM associated with abnormal AET (P ≤.01) and MNBI (P ≤.03); reflux burden was more profound with >70% fragmented as well as ineffective sequences compared to ≤70% for each (P <.05 for each comparison). When weak and failed sequences within IEM were separately analyzed, ≥50% failed sequences predicted abnormal AET (P ≤.009), and ≥50% weak sequences did not (P =.14). On multivariate regression, ≥50% failed sequences predicted abnormal AET (P =.02), and >70% ineffective sequences trended strongly (P =.069); >70% ineffective sequences predicted abnormal MNBI (P =.046), and >70% fragmented sequences trended strongly (P =.076). Conclusions and Inferences: Breaks in esophageal peristaltic integrity seen with fragmented and failed sequences are more relevant to abnormal esophageal acid burden than weak sequences.
KW - acid exposure time
KW - ambulatory pH-impedance monitoring
KW - failed swallows
KW - fragmented peristalsis
KW - ineffective esophageal motility
KW - mean nocturnal baseline impedance
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U2 - 10.1111/nmo.13736
DO - 10.1111/nmo.13736
M3 - Article
C2 - 31574208
AN - SCOPUS:85073930916
VL - 32
JO - Neurogastroenterology and Motility
JF - Neurogastroenterology and Motility
SN - 1350-1925
IS - 2
M1 - e13736
ER -