Esophagogastric junction contractility for clinical assessment in patients with GERD: a real added value?

Background The role of esophagogastric junction contractile integral ( EGJ- CI) as assessed by high-resolution manometry ( HRM) is unclear. We aimed to correlate the EGJ- CI with impedance-pH findings in gastro-esophageal reflux disease ( GERD) patients. Methods Consecutive patients with GERD symptoms were enrolled. All patients underwent upper endoscopy, HRM, and impedance-pH testing. The EGJ- CI was calculated using the distal contractile integral tool box during three consecutive respiratory cycles. The value was then divided by the duration of these cycles. A value below 13 was considered as a defective EGJ- CI. We also assessed EGJ morphology, esophageal acid exposure time ( AET), number of reflux episodes ( NRE), and symptom association analysis ( SAA). A positive impedance-pH monitoring was considered in case of abnormal AET and/or NRE and/or positive SAA. Key Results Among 130 patients we enrolled, 91 had GERD (abnormal AET and/or elevated NRE and/or positive SAA) and 39 had functional heartburn ( FH) (negative endoscopy, normal AET, normal NRE, and negative SAA). The GERD patients had a lower median value of EGJ- CI (11 [3.1-20.7] vs 22 [9.9-41], p < 0.02) compared to FH patients. Patients with a defective EGJ- CI had, more frequently, a positive impedance-pH monitoring or esophageal mucosal lesions at endoscopy ( p < 0.05 and p < 0.05, respectively) than patients with a normal EGJ- CI. An EGJ- CI cut-off value of 5 mmHg cm yielded the optimal performance in identifying GERD at impedance-pH (sensitivity 89%-specificity 63%). Conclusions & Inferences A defective EGJ- CI at HRM is clearly associated with evidence of GERD at impedance-pH monitoring. Evaluating EGJ- CI may be useful to predict an abnormal impedance-pH testing. [ABSTRACT FROM AUTHOR]