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Postreflux swallow‐induced peristaltic wave index from pH‐impedance monitoring associates with esophageal body motility and esophageal acid burden
Author(s) -
Rogers Benjamin D.,
Rengarajan Arvind,
Ribolsi Mentore,
Ghisa Matteo,
Quader Farhan,
Penagini Roberto,
Bortoli Nicola,
Mauro Aurelio,
Cicala Michele,
Savarino Edoardo,
Gyawali C. Prakash
Publication year - 2021
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.13973
Subject(s) - peristalsis , reflux , high resolution manometry , supine position , medicine , swallowing , contraction (grammar) , esophageal ph monitoring , gastroenterology , cardiology , gerd , surgery , disease
Background Postreflux swallow‐induced peristaltic wave (PSPW) on pH‐impedance monitoring and contraction vigor on high‐resolution manometry (HRM) both assess esophageal peristaltic response. We aimed to evaluate relationships between PSPW and esophageal peristalsis on HRM in the context of reflux disease in this multicenter cohort study. Methods pH‐impedance and HRM studies performed on patients with persisting reflux symptoms were reviewed from 6 centers (5 in Europe and 1 in US). Total, upright and supine acid exposure time (AET) were evaluated from pH‐impedance studies; PSPW index (PSPWI) and mean nocturnal baseline impedance (MNBI) were calculated using standard methodology. Esophageal body contraction vigor was analyzed using distal contractile integral (DCI), and DCI ratio > 1 between single swallows and multiple rapid swallows (MRS) defined presence of contraction reserve. Student's t test, ANOVA, and linear regression were utilized to investigate relationships between PSPW, contraction vigor, and contraction reserve. Key Results Of 296 patients (52.8 ± 0.8 yr, 63% F), median PSPWI was 0.475. Only 24.0% had intact DCI; the remainder had varying degrees of hypomotility. As hypomotility increased, PSPWI and MNBI decreased significantly, while total AET and reflux episodes had an inverse response ( P ≤ .002 for each). MRS data were available in 167 (56.4%), 72.5% had contraction reserve. MRS cohorts with normal PSPWI had significantly lower reflux burden compared to low PSPWI, regardless of presence or absence of contraction reserve ( P ≤ .001). Conclusions and Inferences PSPWI correlates with esophageal hypomotility and reflux burden, and complements clinical reflux evaluation. Intact PSPW is more relevant to esophageal reflux clearance than contraction reserve.