Abstract
Gastroesophageal reflux disease (GERD) is a common gastrointestinal disorder. High-resolution esophageal manometry (HREM) and 24-h pH study help to properly evaluate GERD patients. The aim of the present study was to classify patients with refractory GERD symptoms into various groups based on endoscopic and physiological testing. The present study is a retrospective analysis of patients referred for HREM and 24-h pH recording between 2019 and 2021. We included all adult patients (age > 18 years) who were referred for evaluation of refractory GERD symptoms. Upper gastrointestinal endoscopy findings, HREM, and 24-h pH findings were noted. Patients were divided into erosive reflux disease (ERD), non-erosive reflux disease (NERD), reflux hypersensitivity (RH), and functional heartburn (FH) based on test results. Demographic details and HREM parameters were compared in the four groups. Statistics used are one-way analysis of variance (ANOVA) and Chi-squared tests. A p-value of <0.05 was considered statistically significant. A total of 144 patients were included—NERD (56, 38.9%), ERD (42, 29.2%), RH (28, 19.5%), and FH (18, 12.5%). Age (p 0.74), and sex distribution (p 0.47), and symptom profile (p 0.12) were similar. The presence of type 2/3 esophagogastric junction (EGJ) morphology was commoner in ERD and NERD (p <0.001). Moreover, the esophagogastric junction contractile integral (EGJ-CI) and basal inspiratory pressures were significantly lower in these two groups (p<0.05). EGJ-CI was low in 32 cases of ERD (76.2%), 41 cases with NERD (73.2%), 7 cases with RH (25%), and 3 cases with FH (16.7%), respectively (p-value < 0.00001). FH and RH account for 32% of cases with refractory GERD symptoms. Impaired EGJ function was more common in ERD and NERD patients compared to FH and RH patients.
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References
El-Serag HB, Sweet S, Winchester CC, Dent J. Update on the epidemiology of gastro-oesophageal reflux disease: a systematic review. Gut. 2014;63:871–80.
Gyawali CP, Kahrilas PJ, Savarino E, et al. Modern diagnosis of GERD: the Lyon Consensus. Gut. 2018;67:1351–62.
Rengarajan A, Bolkhir A, Gor P, Wang D, Munigala S, Gyawali CP. Esophagogastric junction and esophageal body contraction metrics on high resolution manometry predict esophageal acid burden. Neurogastroenterol Motil. 2018;30:e13267.
Gor P, Li Y, Munigala S, Patel A, Bolkhir A, Gyawali CP. Interrogation of esophagogastric junction barrier function using the esophagogastric junction contractile integral: an observational cohort study. Dis Esophagus. 2016;29:820–8.
Tolone S, de Cassan C, de Bortoli N, et al. Esophagogastric junction morphology is associated with a positive impedance-pH monitoring in patients with GERD. Neurogastroenterol Motil. 2015;27:1175–82.
Kahrilas PJ, Dodds WJ, Hogan WJ, Kern M, Arndorfer RC, Reece A. Esophageal peristaltic dysfunction in peptic esophagitis. Gastroenterology. 1986;91:897–904.
Leite LP, Johnston BT, Barrett J, Castell JA, Castell DO. Ineffective esophageal motility (IEM): the primary finding in patients with nonspecific esophageal motility disorder. Dig Dis Sci. 1997;42:1859–65.
Wang F, Li P, Ji GZ, et al. An analysis of 342 patients with refractory gastroesophageal reflux disease symptoms using questionnaires, high-resolution manometry, and impedance-pH monitoring. Medicine (Baltimore). 2017;96:e5906.
Jain M, Agrawal V. Role of esophageal manometry and 24-h pH testing in patients with refractory reflux symptoms. Indian J Gastroenterol. 2020;39:165–70.
Yadlapati R, Kahrilas PJ, Fox MR, et al. Esophageal motility disorders on high-resolution manometry: Chicago classification version 4.0©. Neurogastroenterol Motil. 2021;33:e14058.
Gyawali CP, Roman S, Bredenoord AJ, et al. Classification of esophageal motor findings in gastro-esophageal reflux disease: conclusions from an international consensus group. Neurogastroenterol Motil. 2017;29. https://doi.org/10.1111/nmo.13104.
Lundell LR, Dent J, Bennett JR, et al. Endoscopic assessment of oesophagitis: clinical and functional correlates and further validation of the Los Angeles classification. Gut. 1999;45:172–80.
Ribolsi M, Savarino E, Rogers B, et al. High-resolution manometry determinants of refractoriness of reflux symptoms to proton pump inhibitor therapy. J Neurogastroenterol Motil. 2020;26:447–54.
Herregods TV, Troelstra M, Weijenborg PW, Bredenoord AJ, Smout AJ. Patients with refractory reflux symptoms often do not have GERD. Neurogastroenterol Motil. 2015;27:1267–73.
Pandolfino JE, Kim H, Ghosh SK, Clarke JO, Zhang Q, Kahrilas PJ. High-resolution manometry of the EGJ: an analysis of crural diaphragm function in GERD. Am J Gastroenterol. 2007;102:1056–63.
Goyal O, Bansal M, Sood A. Esophageal motility disorders: symptomatic and manometric spectrum in Punjab, northern India. Indian J Gastroenterol. 2017;36:202–8.
Somani SK, Ghoshal UC, Saraswat VA, et al. Correlation of esophageal pH and motor abnormalities with endoscopic severity of reflux esophagitis. Dis Esophagus. 2004;17:58–62.
Srinivas M, Jain M, Bawane P, Jayanthi V. Chicago Classification normative metrics in a healthy Indian cohort for a 16-channel water-perfused high-resolution esophageal manometry system. Neurogastroenterol Motil. 2018;30:e13386.
Nicodème F, Pipa-Muniz M, Khanna K, Kahrilas PJ, Pandolfino JE. Quantifying esophagogastric junction contractility with a novel HRM topographic metric, the EGJ-contractile integral: normative values and preliminary evaluation in PPI non-responders. Neurogastroenterol Motil. 2014;26:353–60.
Tolone S, De Bortoli N, Marabotto E, et al. Esophagogastric junction contractility for clinical assessment in patients with GERD: a real added value? Neurogastroenterol Motil. 2015;27:1423–31.
Jasper D, Freitas-Queiroz N, Hollenstein M, et al. Prolonged measurement improves the assessment of the barrier function of the esophago-gastric junction by high-resolution manometry. Neurogastroenterol Motil. 2017;29. https://doi.org/10.1111/nmo.12925.
Wang D, Patel A, Mello M, Shriver A, Gyawali CP. Esophagogastric junction contractile integral (EGJ-CI) quantifies changes in EGJ barrier function with surgical intervention. Neurogastroenterol Motil. 2016;28:639–46.
Xie C, Wang J, Li Y, et al. Esophagogastric junction contractility integral reflected the anti-reflux barrier dysfunction in GERD patients. J Neurogastroenterol Motil. 2017;23:27–33.
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;32:1443–9.
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Jain, M. Esophageal manometry findings in patients with refractory symptoms of gastroesophageal reflux disease. Indian J Gastroenterol 41, 508–512 (2022). https://doi.org/10.1007/s12664-022-01259-y
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DOI: https://doi.org/10.1007/s12664-022-01259-y