Prolonged measurement improves the assessment of the barrier function of the esophago‐gastric junction by high‐resolution manometry

• DOI: 10.1111/nmo.12925
• Publication Date: 2016-08-15T01:56:45Z
• Authors: D. Jasper; N. Freitas‐Queiroz; M. Hollenstein; B. Misselwitz; P. Layer; T. Navarro‐Rodriguez; M. Fox; J. Keller
• Keywords: High resolution manometry; Esophagogastric junction; Esophageal sphincter

Abstract Background Etiology of gastro‐esophageal reflux disease ( GERD ) is multifactorial, but incompetence the esophago‐gastric junction EGJ appears to be crucial importance. Established manometric parameters for assessment barrier function are sub‐optimal, potentially because they reflect only a very brief (up 30 seconds), not necessarily representative period. This prospective, case–control study tested performance novel, high‐resolution manometry HRM in . Methods Patients with symptoms and healthy controls HC underwent standard 24‐hour pH ±impedance measurements. morphology, lower esophageal sphincter pressure integral LES ‐ PI ), contractile CI were compared total‐ , novel parameter summarizing during entire protocol. Esophageal acid exposure ≥4.2%/24 h A‐Reflux‐pos or ≥73 episodes 24 hours V‐Reflux‐pos considered pathological. Key Results Sixty five 452 patients completed 380 (84%) ambulatory reflux‐monitoring. correlated morphology subtypes (all P <.00001). Only was consistently subjects without Total‐ also single best prediction pathological (optimal cut‐off 47 mmHg cm, AUC 0.746, <.0001). value, approximately 1 SD below mean normal showed modest sensitivity 54% positive predictive value 46%, good specificity 85% negative 89% diagnosis. Conclusion & Inferences Total new metric that summarizes contractility over time, allows an improved function. Pathological unlikely if this within upper two‐thirds range.