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Prolonged measurement improves the assessment of the barrier function of the esophago-gastric junction by high-resolution manometry.
Neurogastroenterol Motil. 2017 Feb; 29(2)NM

Abstract

BACKGROUND

Etiology of gastro-esophageal reflux disease (GERD) is multifactorial, but incompetence of the esophago-gastric junction (EGJ) appears to be of crucial importance. Established manometric parameters for assessment of EGJ barrier function are sub-optimal, potentially because they reflect only a very brief (up to 30 seconds), not necessarily representative period. This prospective, case-control study tested the performance of novel, high-resolution manometry (HRM) parameters of EGJ function in the assessment of GERD.

METHODS

Patients with reflux symptoms and healthy controls (HC) underwent standard HRM and 24-hour pH±impedance measurements. EGJ morphology, lower esophageal sphincter pressure integral (LES-PI), EGJ contractile integral (EGJ-CI) were compared with total-EGJ-CI, a novel parameter summarizing EGJ barrier function during the entire HRM protocol. Esophageal acid exposure ≥4.2%/24 h (A-Reflux-pos) or ≥73 reflux episodes in 24 hours (V-Reflux-pos) were considered pathological.

KEY RESULTS

Sixty five HC and 452 patients completed HRM, 380 (84%) patients underwent ambulatory reflux-monitoring. LES-PI, EGJ-CI and total-EGJ-CI correlated with EGJ morphology subtypes (all P<.00001). Only total-EGJ-CI was consistently lower in A-Reflux-pos and V-Reflux-pos subjects compared with HC and patients without GERD. Total-EGJ-CI was also the single best parameter for prediction of pathological reflux (optimal cut-off 47 mmHg cm, AUC 0.746, P<.0001). This cut-off value, approximately 1 SD below the mean normal value, showed modest sensitivity 54% and positive predictive value 46%, but good specificity 85% and negative predictive value 89% for GERD diagnosis.

CONCLUSION & INFERENCES

Total EGJ-CI, a new metric that summarizes EGJ contractility over time, allows an improved assessment of EGJ barrier function. Pathological reflux is unlikely if this metric is within the upper two-thirds of the normal range.

Authors+Show Affiliations

Department of Internal Medicine, Israelitic Hospital, Academic Hospital of the University of Hamburg, Hamburg, Germany.Department of Gastroenterology, University of São Paulo, School of Medicine, São Paulo, Brazil.Department of Gastroenterology and Hepatology, University Hospital of Zurich, Zurich, Switzerland.Department of Gastroenterology and Hepatology, University Hospital of Zurich, Zurich, Switzerland.Department of Internal Medicine, Israelitic Hospital, Academic Hospital of the University of Hamburg, Hamburg, Germany.Department of Gastroenterology, University of São Paulo, School of Medicine, São Paulo, Brazil.Department of Gastroenterology and Hepatology, University Hospital of Zurich, Zurich, Switzerland. Department of Gastroenterology, Abdominal Center, St. Claraspital, Basel, Switzerland.Department of Internal Medicine, Israelitic Hospital, Academic Hospital of the University of Hamburg, Hamburg, Germany.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

27523737

Citation

Jasper, D, et al. "Prolonged Measurement Improves the Assessment of the Barrier Function of the Esophago-gastric Junction By High-resolution Manometry." Neurogastroenterology and Motility : the Official Journal of the European Gastrointestinal Motility Society, vol. 29, no. 2, 2017.
Jasper D, Freitas-Queiroz N, Hollenstein M, et al. Prolonged measurement improves the assessment of the barrier function of the esophago-gastric junction by high-resolution manometry. Neurogastroenterol Motil. 2017;29(2).
Jasper, D., Freitas-Queiroz, N., Hollenstein, M., Misselwitz, B., Layer, P., Navarro-Rodriguez, T., Fox, M., & Keller, J. (2017). Prolonged measurement improves the assessment of the barrier function of the esophago-gastric junction by high-resolution manometry. Neurogastroenterology and Motility : the Official Journal of the European Gastrointestinal Motility Society, 29(2). https://doi.org/10.1111/nmo.12925
Jasper D, et al. Prolonged Measurement Improves the Assessment of the Barrier Function of the Esophago-gastric Junction By High-resolution Manometry. Neurogastroenterol Motil. 2017;29(2) PubMed PMID: 27523737.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Prolonged measurement improves the assessment of the barrier function of the esophago-gastric junction by high-resolution manometry. AU - Jasper,D, AU - Freitas-Queiroz,N, AU - Hollenstein,M, AU - Misselwitz,B, AU - Layer,P, AU - Navarro-Rodriguez,T, AU - Fox,M, AU - Keller,J, Y1 - 2016/08/14/ PY - 2016/05/26/received PY - 2016/07/19/accepted PY - 2016/8/16/pubmed PY - 2018/2/16/medline PY - 2016/8/16/entrez KW - GERD KW - esophageal motility disorders KW - esophago-gastric junction KW - hiatal hernia KW - high-resolution manometry KW - pH-monitoring JF - Neurogastroenterology and motility : the official journal of the European Gastrointestinal Motility Society JO - Neurogastroenterol. Motil. VL - 29 IS - 2 N2 - BACKGROUND: Etiology of gastro-esophageal reflux disease (GERD) is multifactorial, but incompetence of the esophago-gastric junction (EGJ) appears to be of crucial importance. Established manometric parameters for assessment of EGJ barrier function are sub-optimal, potentially because they reflect only a very brief (up to 30 seconds), not necessarily representative period. This prospective, case-control study tested the performance of novel, high-resolution manometry (HRM) parameters of EGJ function in the assessment of GERD. METHODS: Patients with reflux symptoms and healthy controls (HC) underwent standard HRM and 24-hour pH±impedance measurements. EGJ morphology, lower esophageal sphincter pressure integral (LES-PI), EGJ contractile integral (EGJ-CI) were compared with total-EGJ-CI, a novel parameter summarizing EGJ barrier function during the entire HRM protocol. Esophageal acid exposure ≥4.2%/24 h (A-Reflux-pos) or ≥73 reflux episodes in 24 hours (V-Reflux-pos) were considered pathological. KEY RESULTS: Sixty five HC and 452 patients completed HRM, 380 (84%) patients underwent ambulatory reflux-monitoring. LES-PI, EGJ-CI and total-EGJ-CI correlated with EGJ morphology subtypes (all P<.00001). Only total-EGJ-CI was consistently lower in A-Reflux-pos and V-Reflux-pos subjects compared with HC and patients without GERD. Total-EGJ-CI was also the single best parameter for prediction of pathological reflux (optimal cut-off 47 mmHg cm, AUC 0.746, P<.0001). This cut-off value, approximately 1 SD below the mean normal value, showed modest sensitivity 54% and positive predictive value 46%, but good specificity 85% and negative predictive value 89% for GERD diagnosis. CONCLUSION & INFERENCES: Total EGJ-CI, a new metric that summarizes EGJ contractility over time, allows an improved assessment of EGJ barrier function. Pathological reflux is unlikely if this metric is within the upper two-thirds of the normal range. SN - 1365-2982 UR - https://www.unboundmedicine.com/medline/citation/27523737/Prolonged_measurement_improves_the_assessment_of_the_barrier_function_of_the_esophago_gastric_junction_by_high_resolution_manometry_ L2 - https://doi.org/10.1111/nmo.12925 DB - PRIME DP - Unbound Medicine ER -