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Esophagogastric junction contractile integral and morphology: Two high-resolution manometry metrics of the anti-reflux barrier.
J Gastroenterol Hepatol. 2017 Aug; 32(8):1443-1449.JG

Abstract

BACKGROUND AND AIM

We evaluated associations of esophagogastric junction (EGJ) metrics as an anti-reflux barrier with impedance-pH, endoscopic esophagitis, and lower esophageal sphincter (LES) metrics.

METHODS

We reviewed high-resolution manometry data from consecutive patients with gastroesophageal reflux disease (GERD) symptoms who underwent impedance-pH and endoscopy, and asymptomatic volunteers. The EGJ contractile integral (CI) was calculated as the mean contractile integral/second during three respiratory cycles. EGJ morphology was classified according to LES-crural diaphragm (CD) separation.

RESULTS

In total, 137 patients (65 male, age 55 years) and 23 (9 male, age 33 years) controls were enrolled. Twenty-five patients had erosive reflux disease (ERD), 16 had non-erosive reflux disease (NERD), 5 had reflux hypersensitivity, and 91 were not GERD. EGJ-CI were lower in patients with GERD (22.6 [13.8-29.2] mmHg cm) than non-GERD (50.3 [31-69.9] mmHg cm, P < 0.01) and controls (67 [26.7-78.7] mmHg cm). With an EGJ-CI cut-off value of 30 mmHg cm, the area under the curve was 0.814 (0.762-0.896), with 77.8% sensitivity and 81.7% specificity for the prediction of GERD. LES-CD separation was greatest in patients with ERD, followed the NERD, non-GERD, and controls. EGJ morphology type III was associated with a higher DeMeester score (7.9 [1.6-12.6]) than were type II (3.25 [0.9-5.975]) and I (1.75 [0.8-6.2]; P < 0.01). EGJ-CI values were lower in patients with GERD than in others in each EGJ morphology subgroup.

CONCLUSION

Esophagogastric junction contractile integral showed good diagnostic accuracy with high specificity in predicting GERD. LES-CD separation is associated with an increase in acid reflux, but EGJ-CI was associated more strongly with GERD than was EGJ morphology.

Authors+Show Affiliations

Department of Internal Medicine, The College of Medicine, The Catholic University of Korea, Seoul, Korea.Department of Internal Medicine, The College of Medicine, The Catholic University of Korea, Seoul, Korea.Department of Internal Medicine, The College of Medicine, The Catholic University of Korea, Seoul, Korea.Department of Internal Medicine, The College of Medicine, The Catholic University of Korea, Seoul, Korea.Department of Internal Medicine, The College of Medicine, The Catholic University of Korea, Seoul, Korea.Department of Internal Medicine, The College of Medicine, The Catholic University of Korea, Seoul, Korea.Department of Internal Medicine, The College of Medicine, The Catholic University of Korea, Seoul, Korea.Department of Internal Medicine, The College of Medicine, The Catholic University of Korea, Seoul, Korea.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

28061013

Citation

Ham, Hyoju, et al. "Esophagogastric Junction Contractile Integral and Morphology: Two High-resolution Manometry Metrics of the Anti-reflux Barrier." Journal of Gastroenterology and Hepatology, vol. 32, no. 8, 2017, pp. 1443-1449.
Ham H, Cho YK, Lee HH, et al. Esophagogastric junction contractile integral and morphology: Two high-resolution manometry metrics of the anti-reflux barrier. J Gastroenterol Hepatol. 2017;32(8):1443-1449.
Ham, H., Cho, Y. K., Lee, H. H., Yoon, S. B., Lim, C. H., Kim, J. S., Park, J. M., & Choi, M. G. (2017). Esophagogastric junction contractile integral and morphology: Two high-resolution manometry metrics of the anti-reflux barrier. Journal of Gastroenterology and Hepatology, 32(8), 1443-1449. https://doi.org/10.1111/jgh.13720
Ham H, et al. Esophagogastric Junction Contractile Integral and Morphology: Two High-resolution Manometry Metrics of the Anti-reflux Barrier. J Gastroenterol Hepatol. 2017;32(8):1443-1449. PubMed PMID: 28061013.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Esophagogastric junction contractile integral and morphology: Two high-resolution manometry metrics of the anti-reflux barrier. AU - Ham,Hyoju, AU - Cho,Yu Kyung, AU - Lee,Han Hee, AU - Yoon,Seung Bae, AU - Lim,Chul-Hyun, AU - Kim,Jin Su, AU - Park,Jae Myung, AU - Choi,Myung-Gyu, PY - 2016/07/18/received PY - 2016/10/09/revised PY - 2016/12/30/accepted PY - 2017/1/7/pubmed PY - 2017/11/29/medline PY - 2017/1/7/entrez KW - esophagogastric junction KW - gastroesophageal reflux KW - high resolution manometry SP - 1443 EP - 1449 JF - Journal of gastroenterology and hepatology JO - J. Gastroenterol. Hepatol. VL - 32 IS - 8 N2 - BACKGROUND AND AIM: We evaluated associations of esophagogastric junction (EGJ) metrics as an anti-reflux barrier with impedance-pH, endoscopic esophagitis, and lower esophageal sphincter (LES) metrics. METHODS: We reviewed high-resolution manometry data from consecutive patients with gastroesophageal reflux disease (GERD) symptoms who underwent impedance-pH and endoscopy, and asymptomatic volunteers. The EGJ contractile integral (CI) was calculated as the mean contractile integral/second during three respiratory cycles. EGJ morphology was classified according to LES-crural diaphragm (CD) separation. RESULTS: In total, 137 patients (65 male, age 55 years) and 23 (9 male, age 33 years) controls were enrolled. Twenty-five patients had erosive reflux disease (ERD), 16 had non-erosive reflux disease (NERD), 5 had reflux hypersensitivity, and 91 were not GERD. EGJ-CI were lower in patients with GERD (22.6 [13.8-29.2] mmHg cm) than non-GERD (50.3 [31-69.9] mmHg cm, P < 0.01) and controls (67 [26.7-78.7] mmHg cm). With an EGJ-CI cut-off value of 30 mmHg cm, the area under the curve was 0.814 (0.762-0.896), with 77.8% sensitivity and 81.7% specificity for the prediction of GERD. LES-CD separation was greatest in patients with ERD, followed the NERD, non-GERD, and controls. EGJ morphology type III was associated with a higher DeMeester score (7.9 [1.6-12.6]) than were type II (3.25 [0.9-5.975]) and I (1.75 [0.8-6.2]; P < 0.01). EGJ-CI values were lower in patients with GERD than in others in each EGJ morphology subgroup. CONCLUSION: Esophagogastric junction contractile integral showed good diagnostic accuracy with high specificity in predicting GERD. LES-CD separation is associated with an increase in acid reflux, but EGJ-CI was associated more strongly with GERD than was EGJ morphology. SN - 1440-1746 UR - https://www.unboundmedicine.com/medline/citation/28061013/Esophagogastric_junction_contractile_integral_and_morphology:_Two_high_resolution_manometry_metrics_of_the_anti_reflux_barrier_ L2 - https://doi.org/10.1111/jgh.13720 DB - PRIME DP - Unbound Medicine ER -