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Esophagogastric junction contractile integral (EGJ‐CI) quantifies changes in EGJ barrier function with surgical intervention
Author(s) -
Wang D.,
Patel A.,
Mello M.,
Shriver A.,
Gyawali C. P.
Publication year - 2016
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.12757
Subject(s) - esophagogastric junction , medicine , intervention (counseling) , function (biology) , cardiology , gastroenterology , biology , microbiology and biotechnology , psychiatry , adenocarcinoma , cancer
Background Esophagogastric junction contractile integral ( EGJ ‐ CI ) assesses EGJ barrier function on esophageal high resolution manometry ( HRM ). We assessed EGJ ‐ CI values in achalasia and gastroesophageal reflux disease ( GERD ) to determine if postoperative EGJ ‐ CI changes reflected surgical intervention. Methods Twenty‐one achalasia patients (42.8 ± 3.2 years, 62% F) with HRM before and after Heller myotomy ( HM ) and 68 GERD patients (53.9 ± 1.8 years, 66% F) undergoing antireflux surgery ( ARS ) were compared to 21 healthy controls (27.6 ± 0.6 years, 52% F). Esophagogastric junction contractile integral (mmHg.cm) was calculated using the distal contractile integral measurement across the EGJ , measured above the gastric baseline and corrected for respiration. Pre and postsurgical EGJ ‐ CI and conventional lower esophageal sphincter pressure ( LESP ) metrics were compared within and between these groups using non‐parametric tests. Correlation between EGJ ‐ CI and conventional LESP metrics was assessed. Key Results Baseline EGJ ‐ CI was higher in achalasia compared to GERD ( p < 0.001) or controls ( p = 0.03). Esophagogastric junction contractile integral declined by 59.2% after HM in achalasia ( p = 0.001), and increased by 26.3% after ARS in GERD ( p = 0.005). End‐expiratory and basal LESP decreased by 74.5% and 64.5% with HM , but increased by only 17.8% and 4.3% with ARS . Differences were noted between Dor vs Toupet fundoplication in achalasia ( p = 0.007), and partial vs complete ARS in GERD ( p = 0.03). Esophagogastric junction contractile integral correlated modestly with both end‐expiratory and basal LESP (Pearson's r of 0.8 for all), but was less robust in GERD (0.7). Conclusions & Inferences Esophagogastric junction contractile integral has clinical utility in assessing EGJ barrier function at baseline and after surgical intervention to the EGJ , and could complement conventional EGJ metrics.