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Fragmented and failed swallows on esophageal high‐resolution manometry associate with abnormal reflux burden better than weak swallows
Author(s) -
Rogers Benjamin D.,
Rengarajan Arvind,
Mauro Aurelio,
Ghisa Matteo,
De Bortoli Nicola,
Cicala Michele,
Ribolsi Mentore,
Penagini Roberto,
Savarino Edoardo,
Gyawali C. Prakash
Publication year - 2020
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.13736
Subject(s) - reflux , high resolution manometry , medicine , ambulatory , univariate analysis , peristalsis , gastroenterology , esophageal ph monitoring , multivariate analysis , cardiology , gerd , disease
Background Association between proportions of hypomotile swallows on esophageal high‐resolution manometry (HRM) and esophageal reflux burden remains incompletely understood. We investigated relationships between hypomotility, acid exposure time (AET), and mean nocturnal baseline impedance (MNBI) on ambulatory reflux monitoring. Methods Clinical data, HRM, and ambulatory pH‐impedance studies (performed off acid suppression) from patients with persisting reflux symptoms were reviewed from five international centers. AET (abnormal > 6%) and MNBI (abnormal < 2292 ohms) were extracted from pH‐impedance studies. Distal contractile integral (DCI) designated esophageal peristalsis into normal (DCI > 450 mmHg.cm.s), fragmented (DCI > 450 mmHg.cm.s with breaks > 5 cm), weak (DCI 100‐450 mmHg.cm.s), and failed (DCI < 100 mm mmHg.cm.s) sequences. Univariate and multivariate analyses were performed to identify motor associations of abnormal reflux burden. Key Results Of 351 patients (52.1 ± 0.8 years, 67%F), 29.3% had AET > 6% and 61.8% had MNBI < 2292 ohms. On univariate analysis, both fragmented peristalsis and IEM associated with abnormal AET ( P ≤ .01) and MNBI ( P ≤ .03); reflux burden was more profound with >70% fragmented as well as ineffective sequences compared to ≤70% for each ( P < .05 for each comparison). When weak and failed sequences within IEM were separately analyzed, ≥50% failed sequences predicted abnormal AET ( P ≤ .009), and ≥50% weak sequences did not ( P = .14). On multivariate regression, ≥50% failed sequences predicted abnormal AET ( P = .02), and >70% ineffective sequences trended strongly ( P = .069); >70% ineffective sequences predicted abnormal MNBI ( P = .046), and >70% fragmented sequences trended strongly ( P = .076). Conclusions and Inferences Breaks in esophageal peristaltic integrity seen with fragmented and failed sequences are more relevant to abnormal esophageal acid burden than weak sequences.