Premium
Esophagogastric junction morphology is associated with a positive impedance‐ pH monitoring in patients with GERD
Author(s) -
Tolone S.,
Cassan C.,
Bortoli N.,
Roman S.,
Galeazzi F.,
Salvador R.,
Marabotto E.,
Furnari M.,
Zentilin P.,
Marchi S.,
Bardini R.,
Sturniolo G. C.,
Savarino V.,
Savarino E.
Publication year - 2015
Publication title -
neurogastroenterology and motility
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.489
H-Index - 105
eISSN - 1365-2982
pISSN - 1350-1925
DOI - 10.1111/nmo.12606
Subject(s) - gerd , reflux , high resolution manometry , gastroenterology , medicine , esophagogastric junction , disease , adenocarcinoma , cancer
Background High‐resolution manometry ( HRM ) provides information on esophagogastric junction ( EGJ ) morphology, distinguishing three different subtypes. Data on the correlation between EGJ subtypes and impedance‐pH detected reflux patterns are lacking. We aimed to correlate the EGJ subtypes with impedance‐pH findings in patients with reflux symptoms. Methods Consecutive patients with suspected gastroesophageal reflux disease ( GERD ) were enrolled. All patients underwent HRM and impedance‐pH testing off‐therapy. EGJ was classified as: Type I, no separation between the lower esophageal sphincter ( LES ) and crural diaphragm ( CD ); Type II, minimal separation (>1 and <2 cm); Type III, ≥2 cm separation. We measured esophageal acid exposure time ( AET ), number of total reflux episodes and symptom association analysis. Key Results We enrolled 130 consecutive patients and identified 46.2% Type I EGJ , 38.5% Type II, and 15.4% Type III patients. Type III subjects had a higher number of reflux episodes (61 vs 45, p < 0.03, vs 25, p < 0.001), a greater mean AET (12.4 vs 4.2, p < 0.02, vs 1.5, p < 0.001) and a greater positive symptom association (75% vs 72%, p = 0.732 vs 43.3%, p < 0.02) compared with Type II and I patients, respectively. Furthermore, Type II subjects showed statistically significant (overall p < 0.01) increased reflux when compared with Type I patients. Type III and II EGJ morphologies had a more frequent probability to show a positive multichannel intraluminal impedance pH monitoring than Type I (95% vs 84% vs 50%, p < 0.001). Conclusions & Inferences Increasing separation between LES and CD can cause a gradual and significant increase in reflux. EGJ morphology may be useful to estimate an abnormal impedance‐pH testing in GERD patients.