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Esophagogastric junction contractility for clinical assessment in patients with GERD: a real added value?
Neurogastroenterol Motil. 2015 Oct; 27(10):1423-31.NM

Abstract

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.

Authors+Show Affiliations

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

Pub Type(s)

Journal Article

Language

eng

PubMed ID

26227513

Citation

Tolone, S, et al. "Esophagogastric Junction Contractility for Clinical Assessment in Patients With GERD: a Real Added Value?" Neurogastroenterology and Motility : the Official Journal of the European Gastrointestinal Motility Society, vol. 27, no. 10, 2015, pp. 1423-31.
Tolone S, De Bortoli N, Marabotto E, et al. Esophagogastric junction contractility for clinical assessment in patients with GERD: a real added value? Neurogastroenterol Motil. 2015;27(10):1423-31.
Tolone, S., De Bortoli, N., Marabotto, E., de Cassan, C., Bodini, G., Roman, S., Furnari, M., Savarino, V., Docimo, L., & Savarino, E. (2015). Esophagogastric junction contractility for clinical assessment in patients with GERD: a real added value? Neurogastroenterology and Motility : the Official Journal of the European Gastrointestinal Motility Society, 27(10), 1423-31. https://doi.org/10.1111/nmo.12638
Tolone S, et al. Esophagogastric Junction Contractility for Clinical Assessment in Patients With GERD: a Real Added Value. Neurogastroenterol Motil. 2015;27(10):1423-31. PubMed PMID: 26227513.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Esophagogastric junction contractility for clinical assessment in patients with GERD: 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, Y1 - 2015/07/30/ PY - 2015/04/03/received PY - 2015/06/23/accepted PY - 2015/8/1/entrez PY - 2015/8/1/pubmed PY - 2016/7/7/medline KW - EGJ contractile integral KW - GERD KW - esophagogastric junction KW - high-resolution manometry KW - impedance-pH monitoring SP - 1423 EP - 31 JF - Neurogastroenterology and motility : the official journal of the European Gastrointestinal Motility Society JO - Neurogastroenterol. Motil. VL - 27 IS - 10 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. SN - 1365-2982 UR - https://www.unboundmedicine.com/medline/citation/26227513/Esophagogastric_junction_contractility_for_clinical_assessment_in_patients_with_GERD:_a_real_added_value L2 - https://doi.org/10.1111/nmo.12638 DB - PRIME DP - Unbound Medicine ER -