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Esophagogastric junction and esophageal body contraction metrics on high-resolution manometry predict esophageal acid burden.
Neurogastroenterol Motil. 2018 05; 30(5):e13267.NM

Abstract

BACKGROUND

Distal contractile integral (DCI) and esophagogastric junction contractile integral (EGJ-CI) are high-resolution manometry (HRM) software metrics assessing esophageal motor function in gastroesophageal reflux disease (GERD).

METHODS

Patients undergoing HRM and ambulatory pH monitoring off antisecretory therapy prospectively completed symptom questionnaires assessing symptom burden and a global symptom score (GSS) at baseline and after GERD therapy. DCI<450 mm Hg/cm/s in ≥5 swallows diagnosed ineffective esophageal motility (IEM); proportions of failed (DCI<100 mm Hg/cm/s) and weak (DCI 100-450 mm Hg/cm/s) sequences were separately assessed. EGJ-CI assessed vigor of the EGJ barrier. Univariate and multivariate analyses addressed performance of esophageal body and EGJ metrics in predicting abnormal esophageal reflux burden, and symptom outcome from antireflux therapy.

KEY RESULTS

Of 188 patients (55.2 ± 0.9 year, 64% F), 42.6% had low EGJ-CI, and 25.0% had IEM. While low EGJ-CI was associated with abnormal reflux burden (P = 0.003), IEM alone was not (P = 0.2). Increasing proportions of failed swallows predicted abnormal AET better than the current IEM definition. Combined low EGJ-CI and IEM segregated abnormal total and supine acid burden compared to patients with normal EGJ-CI and no IEM (P ≤ 0.007 for each comparison). Medical therapy and surgical antireflux therapy were similarly effective in improving symptom burden; surgery resulted in better outcomes with low EGJ-CI (P ≤ 0.04), especially with intact esophageal body motor function (P = 0.02).

CONCLUSIONS & INFERENCES

While abnormal EGJ and esophageal body metrics are collectively associated with elevated esophageal reflux burden, increasing proportions of failed swallows are better predictors of reflux burden and outcome compared to the current IEM definition.

Authors+Show Affiliations

Division of Gastroenterology, Washington University School of Medicine, Saint Louis, MO, USA.Division of Gastroenterology, Washington University School of Medicine, Saint Louis, MO, USA.Division of Gastroenterology, Washington University School of Medicine, Saint Louis, MO, USA.Division of Gastroenterology, Washington University School of Medicine, Saint Louis, MO, USA.Division of Gastroenterology, Washington University School of Medicine, Saint Louis, MO, USA.Division of Gastroenterology, Washington University School of Medicine, Saint Louis, MO, USA.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

29266647

Citation

Rengarajan, A, et al. "Esophagogastric Junction and Esophageal Body Contraction Metrics On High-resolution Manometry Predict Esophageal Acid Burden." Neurogastroenterology and Motility : the Official Journal of the European Gastrointestinal Motility Society, vol. 30, no. 5, 2018, pp. e13267.
Rengarajan A, Bolkhir A, Gor P, et al. Esophagogastric junction and esophageal body contraction metrics on high-resolution manometry predict esophageal acid burden. Neurogastroenterol Motil. 2018;30(5):e13267.
Rengarajan, A., Bolkhir, A., Gor, P., Wang, D., Munigala, S., & Gyawali, C. P. (2018). Esophagogastric junction and esophageal body contraction metrics on high-resolution manometry predict esophageal acid burden. Neurogastroenterology and Motility : the Official Journal of the European Gastrointestinal Motility Society, 30(5), e13267. https://doi.org/10.1111/nmo.13267
Rengarajan A, et al. Esophagogastric Junction and Esophageal Body Contraction Metrics On High-resolution Manometry Predict Esophageal Acid Burden. Neurogastroenterol Motil. 2018;30(5):e13267. PubMed PMID: 29266647.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Esophagogastric junction and esophageal body contraction metrics on high-resolution manometry predict esophageal acid burden. AU - Rengarajan,A, AU - Bolkhir,A, AU - Gor,P, AU - Wang,D, AU - Munigala,S, AU - Gyawali,C P, Y1 - 2017/12/21/ PY - 2017/10/16/received PY - 2017/11/27/accepted PY - 2017/12/22/pubmed PY - 2019/10/17/medline PY - 2017/12/22/entrez KW - gastroesophageal reflux disease KW - high-resolution manometry KW - ineffective esophageal motility SP - e13267 EP - e13267 JF - Neurogastroenterology and motility : the official journal of the European Gastrointestinal Motility Society JO - Neurogastroenterol. Motil. VL - 30 IS - 5 N2 - BACKGROUND: Distal contractile integral (DCI) and esophagogastric junction contractile integral (EGJ-CI) are high-resolution manometry (HRM) software metrics assessing esophageal motor function in gastroesophageal reflux disease (GERD). METHODS: Patients undergoing HRM and ambulatory pH monitoring off antisecretory therapy prospectively completed symptom questionnaires assessing symptom burden and a global symptom score (GSS) at baseline and after GERD therapy. DCI<450 mm Hg/cm/s in ≥5 swallows diagnosed ineffective esophageal motility (IEM); proportions of failed (DCI<100 mm Hg/cm/s) and weak (DCI 100-450 mm Hg/cm/s) sequences were separately assessed. EGJ-CI assessed vigor of the EGJ barrier. Univariate and multivariate analyses addressed performance of esophageal body and EGJ metrics in predicting abnormal esophageal reflux burden, and symptom outcome from antireflux therapy. KEY RESULTS: Of 188 patients (55.2 ± 0.9 year, 64% F), 42.6% had low EGJ-CI, and 25.0% had IEM. While low EGJ-CI was associated with abnormal reflux burden (P = 0.003), IEM alone was not (P = 0.2). Increasing proportions of failed swallows predicted abnormal AET better than the current IEM definition. Combined low EGJ-CI and IEM segregated abnormal total and supine acid burden compared to patients with normal EGJ-CI and no IEM (P ≤ 0.007 for each comparison). Medical therapy and surgical antireflux therapy were similarly effective in improving symptom burden; surgery resulted in better outcomes with low EGJ-CI (P ≤ 0.04), especially with intact esophageal body motor function (P = 0.02). CONCLUSIONS & INFERENCES: While abnormal EGJ and esophageal body metrics are collectively associated with elevated esophageal reflux burden, increasing proportions of failed swallows are better predictors of reflux burden and outcome compared to the current IEM definition. SN - 1365-2982 UR - https://www.unboundmedicine.com/medline/citation/29266647/Esophagogastric_junction_and_esophageal_body_contraction_metrics_on_high_resolution_manometry_predict_esophageal_acid_burden_ L2 - https://doi.org/10.1111/nmo.13267 DB - PRIME DP - Unbound Medicine ER -