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Esophagogastric Junction Morphology and Distal Esophageal Acid Exposure.
Dig Dis Sci. 2016 12; 61(12):3537-3544.DD

Abstract

BACKGROUND

The Chicago classification has recently added a morphological subclassification for the esophagogastric junction (EGJ). Our aim was to assess the distal esophageal acid exposure in patients with this new Chicago EGJ-type IIIa and IIIb classification.

STUDY DESIGN

From a prospectively collected high-resolution manometry (HRM) database, we identified patients who underwent 24-h pH study between October 2011 and June 2015 and were diagnosed with EGJ-type III based on HRM. Chicago EGJ-type III is defined as the inter-peak nadir pressure ≤gastric pressure and a lower esophageal sphincter (LES)-crural diaphragm (CD) separation >2 cm [IIIa-pressure inversion point (PIP) remains at CD level and IIIb-PIP remains at LES level]. We classified the patients into reflux group [DeMeester score >14.72 or Fraction time pH (<4) > 4.2 %] and non-reflux group based on 24-h pH study.

RESULTS

Fifty patients were identified that satisfied the study criteria, of which 37 patients (74 %) were EGJ-type IIIa. In those with EGJ-type IIIb, abdominal LES length (AL) in reflux group was significantly shorter than the non-reflux group (0.8 vs. 1.8, p < 0.05). EGJ-type IIIa patients showed significantly higher value for DeMeester score and Fraction time pH and more often had a positive pH study than EGJ-type IIIb patients (DeMeester score: 26.7 vs. 11.7, p < 0.05; Fraction time pH: 7.9 vs. 2.6, p < 0.05; positive pH study: 81.1 vs. 30.8 %, p < 0.001). Reflux was more common in LES-CD ≥ 3 cm than that in LES-CD < 3 cm (85 vs. 56.7 %, p < 0.05).

CONCLUSION

A subset of patients with >2-cm LES-CD separation (type IIIb) maintain a physiological intra-abdominal location of the EGJ and are less likely to have reflux. A LES-CD ≥ 3 cm seems to discern a hiatus hernia of clinical significance.

Authors+Show Affiliations

Department of Surgery, Creighton University School of Medicine, Creighton University Medical Center, Omaha, NE, 68131, USA.Creighton University School of Medicine (Phoenix Campus), Phoenix, AZ, 85013, USA.Creighton University School of Medicine (Phoenix Campus), Phoenix, AZ, 85013, USA.Department of Surgery, Creighton University School of Medicine, Creighton University Medical Center, Omaha, NE, 68131, USA.Department of Surgery, Creighton University School of Medicine, Creighton University Medical Center, Omaha, NE, 68131, USA.Department of Surgery, Creighton University School of Medicine, Creighton University Medical Center, Omaha, NE, 68131, USA. Sumeet.Mittal@DignityHealth.org. Creighton University School of Medicine (Phoenix Campus), Phoenix, AZ, 85013, USA. Sumeet.Mittal@DignityHealth.org. Norton Thoracic Institute, St Joesph's Hospital and Medical Center, Dignity Health, Phoenix, AZ, 85013, USA. Sumeet.Mittal@DignityHealth.org.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

27730315

Citation

Akimoto, Shunsuke, et al. "Esophagogastric Junction Morphology and Distal Esophageal Acid Exposure." Digestive Diseases and Sciences, vol. 61, no. 12, 2016, pp. 3537-3544.
Akimoto S, Singhal S, Masuda T, et al. Esophagogastric Junction Morphology and Distal Esophageal Acid Exposure. Dig Dis Sci. 2016;61(12):3537-3544.
Akimoto, S., Singhal, S., Masuda, T., Yamamoto, S. R., Svetanoff, W. J., & Mittal, S. K. (2016). Esophagogastric Junction Morphology and Distal Esophageal Acid Exposure. Digestive Diseases and Sciences, 61(12), 3537-3544.
Akimoto S, et al. Esophagogastric Junction Morphology and Distal Esophageal Acid Exposure. Dig Dis Sci. 2016;61(12):3537-3544. PubMed PMID: 27730315.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Esophagogastric Junction Morphology and Distal Esophageal Acid Exposure. AU - Akimoto,Shunsuke, AU - Singhal,Saurabh, AU - Masuda,Takahiro, AU - Yamamoto,Se Ryung, AU - Svetanoff,Wendy Jo, AU - Mittal,Sumeet K, Y1 - 2016/10/11/ PY - 2016/07/28/received PY - 2016/09/26/accepted PY - 2016/10/13/pubmed PY - 2017/7/8/medline PY - 2016/10/13/entrez KW - Crural diaphragm KW - Gastroesophageal reflux disease KW - Hiatal hernia KW - High-resolution manometry KW - Lower esophageal sphincter KW - Pressure inversion point SP - 3537 EP - 3544 JF - Digestive diseases and sciences JO - Dig. Dis. Sci. VL - 61 IS - 12 N2 - BACKGROUND: The Chicago classification has recently added a morphological subclassification for the esophagogastric junction (EGJ). Our aim was to assess the distal esophageal acid exposure in patients with this new Chicago EGJ-type IIIa and IIIb classification. STUDY DESIGN: From a prospectively collected high-resolution manometry (HRM) database, we identified patients who underwent 24-h pH study between October 2011 and June 2015 and were diagnosed with EGJ-type III based on HRM. Chicago EGJ-type III is defined as the inter-peak nadir pressure ≤gastric pressure and a lower esophageal sphincter (LES)-crural diaphragm (CD) separation >2 cm [IIIa-pressure inversion point (PIP) remains at CD level and IIIb-PIP remains at LES level]. We classified the patients into reflux group [DeMeester score >14.72 or Fraction time pH (<4) > 4.2 %] and non-reflux group based on 24-h pH study. RESULTS: Fifty patients were identified that satisfied the study criteria, of which 37 patients (74 %) were EGJ-type IIIa. In those with EGJ-type IIIb, abdominal LES length (AL) in reflux group was significantly shorter than the non-reflux group (0.8 vs. 1.8, p < 0.05). EGJ-type IIIa patients showed significantly higher value for DeMeester score and Fraction time pH and more often had a positive pH study than EGJ-type IIIb patients (DeMeester score: 26.7 vs. 11.7, p < 0.05; Fraction time pH: 7.9 vs. 2.6, p < 0.05; positive pH study: 81.1 vs. 30.8 %, p < 0.001). Reflux was more common in LES-CD ≥ 3 cm than that in LES-CD < 3 cm (85 vs. 56.7 %, p < 0.05). CONCLUSION: A subset of patients with >2-cm LES-CD separation (type IIIb) maintain a physiological intra-abdominal location of the EGJ and are less likely to have reflux. A LES-CD ≥ 3 cm seems to discern a hiatus hernia of clinical significance. SN - 1573-2568 UR - https://www.unboundmedicine.com/medline/citation/27730315/Esophagogastric_Junction_Morphology_and_Distal_Esophageal_Acid_Exposure_ L2 - https://doi.org/10.1007/s10620-016-4331-y DB - PRIME DP - Unbound Medicine ER -