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Esophagogastric junction morphology is associated with a positive impedance-pH monitoring in patients with GERD.
Neurogastroenterol Motil. 2015 Aug; 27(8):1175-82.NM

Abstract

BACKGROUND

High-resolution manometry (HRM) provides information on esophagogastric junction (EGJ) morphology, distinguishing three different subtypes. Data on the correlation between EGJ subtypes and impedance-pH detected reflux patterns are lacking. We aimed to correlate the EGJ subtypes with impedance-pH findings in patients with reflux symptoms.

METHODS

Consecutive patients with suspected gastroesophageal reflux disease (GERD) were enrolled. All patients underwent HRM and impedance-pH testing off-therapy. EGJ was classified as: Type I, no separation between the lower esophageal sphincter (LES) and crural diaphragm (CD); Type II, minimal separation (>1 and <2 cm); Type III, ≥ 2 cm separation. We measured esophageal acid exposure time (AET), number of total reflux episodes and symptom association analysis.

KEY RESULTS

We enrolled 130 consecutive patients and identified 46.2% Type I EGJ, 38.5% Type II, and 15.4% Type III patients. Type III subjects had a higher number of reflux episodes (61 vs 45, p < 0.03, vs 25, p < 0.001), a greater mean AET (12.4 vs 4.2, p < 0.02, vs 1.5, p < 0.001) and a greater positive symptom association (75% vs 72%, p = 0.732 vs 43.3%, p < 0.02) compared with Type II and I patients, respectively. Furthermore, Type II subjects showed statistically significant (overall p < 0.01) increased reflux when compared with Type I patients. Type III and II EGJ morphologies had a more frequent probability to show a positive multichannel intraluminal impedance pH monitoring than Type I (95% vs 84% vs 50%, p < 0.001).

CONCLUSIONS & INFERENCES

Increasing separation between LES and CD can cause a gradual and significant increase in reflux. EGJ morphology may be useful to estimate an abnormal impedance-pH testing in GERD patients.

Authors+Show Affiliations

Division of Surgery, Department of Surgery, Second University of Naples, Naples, Italy.Division of Gastroenterology, Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy.Division of Gastroenterology, Department of Internal Medicine, University of Pisa, Pisa, Italy.Digestive Physiology, Hospices Civils de Lyon, Lyon I University and Labtau, INSERM 1032, Lyon, France.Division of Gastroenterology, Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy.U.O. Chirurgia Generale, Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy.Division of Gastroenterology, Department of Internal Medicine, University of Genoa, Genoa, Italy.Division of Gastroenterology, Department of Internal Medicine, University of Genoa, Genoa, Italy.Division of Gastroenterology, Department of Internal Medicine, University of Genoa, Genoa, Italy.Division of Gastroenterology, Department of Internal Medicine, University of Pisa, Pisa, Italy.U.O. Chirurgia Generale, Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy.Division of Gastroenterology, Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy.Division of Gastroenterology, Department of Internal Medicine, University of Genoa, Genoa, Italy.Division of Gastroenterology, Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

26010058

Citation

Tolone, S, et al. "Esophagogastric Junction Morphology Is Associated With a Positive impedance-pH Monitoring in Patients With GERD." Neurogastroenterology and Motility : the Official Journal of the European Gastrointestinal Motility Society, vol. 27, no. 8, 2015, pp. 1175-82.
Tolone S, de Cassan C, de Bortoli N, et al. Esophagogastric junction morphology is associated with a positive impedance-pH monitoring in patients with GERD. Neurogastroenterol Motil. 2015;27(8):1175-82.
Tolone, S., de Cassan, C., de Bortoli, N., Roman, S., Galeazzi, F., Salvador, R., Marabotto, E., Furnari, M., Zentilin, P., Marchi, S., Bardini, R., Sturniolo, G. C., Savarino, V., & Savarino, E. (2015). Esophagogastric junction morphology is associated with a positive impedance-pH monitoring in patients with GERD. Neurogastroenterology and Motility : the Official Journal of the European Gastrointestinal Motility Society, 27(8), 1175-82. https://doi.org/10.1111/nmo.12606
Tolone S, et al. Esophagogastric Junction Morphology Is Associated With a Positive impedance-pH Monitoring in Patients With GERD. Neurogastroenterol Motil. 2015;27(8):1175-82. PubMed PMID: 26010058.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Esophagogastric junction morphology is associated with a positive impedance-pH monitoring in patients with GERD. AU - Tolone,S, AU - de Cassan,C, AU - de Bortoli,N, AU - Roman,S, AU - Galeazzi,F, AU - Salvador,R, AU - Marabotto,E, AU - Furnari,M, AU - Zentilin,P, AU - Marchi,S, AU - Bardini,R, AU - Sturniolo,G C, AU - Savarino,V, AU - Savarino,E, Y1 - 2015/05/25/ PY - 2015/03/01/received PY - 2015/04/29/accepted PY - 2015/5/27/entrez PY - 2015/5/27/pubmed PY - 2016/5/4/medline KW - GERD KW - esophagogastric junction KW - high-resolution manometry KW - impedance monitoring SP - 1175 EP - 82 JF - Neurogastroenterology and motility : the official journal of the European Gastrointestinal Motility Society JO - Neurogastroenterol. Motil. VL - 27 IS - 8 N2 - BACKGROUND: High-resolution manometry (HRM) provides information on esophagogastric junction (EGJ) morphology, distinguishing three different subtypes. Data on the correlation between EGJ subtypes and impedance-pH detected reflux patterns are lacking. We aimed to correlate the EGJ subtypes with impedance-pH findings in patients with reflux symptoms. METHODS: Consecutive patients with suspected gastroesophageal reflux disease (GERD) were enrolled. All patients underwent HRM and impedance-pH testing off-therapy. EGJ was classified as: Type I, no separation between the lower esophageal sphincter (LES) and crural diaphragm (CD); Type II, minimal separation (>1 and <2 cm); Type III, ≥ 2 cm separation. We measured esophageal acid exposure time (AET), number of total reflux episodes and symptom association analysis. KEY RESULTS: We enrolled 130 consecutive patients and identified 46.2% Type I EGJ, 38.5% Type II, and 15.4% Type III patients. Type III subjects had a higher number of reflux episodes (61 vs 45, p < 0.03, vs 25, p < 0.001), a greater mean AET (12.4 vs 4.2, p < 0.02, vs 1.5, p < 0.001) and a greater positive symptom association (75% vs 72%, p = 0.732 vs 43.3%, p < 0.02) compared with Type II and I patients, respectively. Furthermore, Type II subjects showed statistically significant (overall p < 0.01) increased reflux when compared with Type I patients. Type III and II EGJ morphologies had a more frequent probability to show a positive multichannel intraluminal impedance pH monitoring than Type I (95% vs 84% vs 50%, p < 0.001). CONCLUSIONS & INFERENCES: Increasing separation between LES and CD can cause a gradual and significant increase in reflux. EGJ morphology may be useful to estimate an abnormal impedance-pH testing in GERD patients. SN - 1365-2982 UR - https://www.unboundmedicine.com/medline/citation/26010058/Esophagogastric_junction_morphology_is_associated_with_a_positive_impedance_pH_monitoring_in_patients_with_GERD_ L2 - https://doi.org/10.1111/nmo.12606 DB - PRIME DP - Unbound Medicine ER -