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Straight leg raise metrics on high-resolution manometry associate with esophageal reflux burden.
Neurogastroenterol Motil. 2020 Jul 06 [Online ahead of print]NM

Abstract

BACKGROUND

Straight leg raise (SLR) is a provocative maneuver that assesses esophagogastric junction (EGJ) barrier function during high-resolution manometry (HRM). We evaluated the value of SLR in symptomatic reflux patients undergoing ambulatory reflux monitoring.

METHODS

Adult patients being evaluated for reflux symptoms with esophageal physiologic testing off antisecretory therapy over a 12 month period were studied. Demographics, clinical presentation, HRM studies, and reflux monitoring studies were analyzed. Intra-abdominal and intra-esophageal pressures were extracted at baseline and during SLR from HRM studies. Acid exposure time (AET) was derived from reflux monitoring studies, and EGJ morphology and tone from HRM studies. SLR pressure metrics predicting abnormal AET were evaluated.

KEY RESULTS

Of 122 patients, 70 (57.4%) had ≥50% peak intra-abdominal pressure increase during SLR (58.0 ± 1.4 years, 75.7% female). Peak intra-esophageal pressure gradient between baseline and SLR predicted pathologic AET when ≥100% (AUC 0.78, sensitivity 71%, specificity 75%, P < .001), seen in 60.7% with AET > 6%, but only 23.7% with AET < 4% (P = .01). Peak intra-esophageal pressure gradient ≥100% was most discriminative in identifying abnormal acid burden in type 1 EGJ morphology (P = .005) but trended toward significance in type 2 and type 3 morphology (P = .1). Normal and abnormal EGJ contractile integral did not associate with peak intra-esophageal pressure gradient either collectively or when subdivided by EGJ morphology (P ≥ .2).

CONCLUSIONS & INFERENCES

Analysis of intra-esophageal pressure gradients during SLR, a simple HRM maneuver, may augment evaluation of symptomatic GERD, and provide adjunctive evidence supporting GERD.

Authors+Show Affiliations

Division of Gastroenterology, Washington University School of Medicine, St Louis, MO, USA.Division of Gastroenterology, Washington University School of Medicine, St Louis, MO, USA.Section on Digestive Diseases and Nutrition, University of Oklahoma School of Medicine, Oklahoma City, OK, USA.Division of Gastroenterology, Washington University School of Medicine, St Louis, MO, USA.Division of Gastroenterology, Washington University School of Medicine, St Louis, MO, USA.Division of Gastroenterology, Washington University School of Medicine, St Louis, MO, USA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32633016

Citation

Rogers, Benjamin D., et al. "Straight Leg Raise Metrics On High-resolution Manometry Associate With Esophageal Reflux Burden." Neurogastroenterology and Motility : the Official Journal of the European Gastrointestinal Motility Society, 2020, pp. e13929.
Rogers BD, Rengarajan A, Ali IA, et al. Straight leg raise metrics on high-resolution manometry associate with esophageal reflux burden. Neurogastroenterol Motil. 2020.
Rogers, B. D., Rengarajan, A., Ali, I. A., Hasak, S. L., Hansalia, V., & Gyawali, C. P. (2020). Straight leg raise metrics on high-resolution manometry associate with esophageal reflux burden. Neurogastroenterology and Motility : the Official Journal of the European Gastrointestinal Motility Society, e13929. https://doi.org/10.1111/nmo.13929
Rogers BD, et al. Straight Leg Raise Metrics On High-resolution Manometry Associate With Esophageal Reflux Burden. Neurogastroenterol Motil. 2020 Jul 6;e13929. PubMed PMID: 32633016.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Straight leg raise metrics on high-resolution manometry associate with esophageal reflux burden. AU - Rogers,Benjamin D, AU - Rengarajan,Arvind, AU - Ali,Ijlal A, AU - Hasak,Stephen L, AU - Hansalia,Vivek, AU - Gyawali,C Prakash, Y1 - 2020/07/06/ PY - 2020/04/17/received PY - 2020/05/25/revised PY - 2020/06/02/accepted PY - 2020/7/8/entrez KW - acid exposure time KW - gastroesophageal reflux disease KW - high-resolution manometry KW - straight leg raise maneuver SP - e13929 EP - e13929 JF - Neurogastroenterology and motility : the official journal of the European Gastrointestinal Motility Society JO - Neurogastroenterol. Motil. N2 - BACKGROUND: Straight leg raise (SLR) is a provocative maneuver that assesses esophagogastric junction (EGJ) barrier function during high-resolution manometry (HRM). We evaluated the value of SLR in symptomatic reflux patients undergoing ambulatory reflux monitoring. METHODS: Adult patients being evaluated for reflux symptoms with esophageal physiologic testing off antisecretory therapy over a 12 month period were studied. Demographics, clinical presentation, HRM studies, and reflux monitoring studies were analyzed. Intra-abdominal and intra-esophageal pressures were extracted at baseline and during SLR from HRM studies. Acid exposure time (AET) was derived from reflux monitoring studies, and EGJ morphology and tone from HRM studies. SLR pressure metrics predicting abnormal AET were evaluated. KEY RESULTS: Of 122 patients, 70 (57.4%) had ≥50% peak intra-abdominal pressure increase during SLR (58.0 ± 1.4 years, 75.7% female). Peak intra-esophageal pressure gradient between baseline and SLR predicted pathologic AET when ≥100% (AUC 0.78, sensitivity 71%, specificity 75%, P < .001), seen in 60.7% with AET > 6%, but only 23.7% with AET < 4% (P = .01). Peak intra-esophageal pressure gradient ≥100% was most discriminative in identifying abnormal acid burden in type 1 EGJ morphology (P = .005) but trended toward significance in type 2 and type 3 morphology (P = .1). Normal and abnormal EGJ contractile integral did not associate with peak intra-esophageal pressure gradient either collectively or when subdivided by EGJ morphology (P ≥ .2). CONCLUSIONS & INFERENCES: Analysis of intra-esophageal pressure gradients during SLR, a simple HRM maneuver, may augment evaluation of symptomatic GERD, and provide adjunctive evidence supporting GERD. SN - 1365-2982 UR - https://www.unboundmedicine.com/medline/citation/32633016/Straight_leg_raise_metrics_on_high-resolution_manometry_associate_with_esophageal_reflux_burden L2 - https://doi.org/10.1111/nmo.13929 DB - PRIME DP - Unbound Medicine ER -
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