Esophagogastric junction contractile integral and morphology: Two high-resolution manometry metrics of the anti-reflux barrier.
BACKGROUND AND AIM
We evaluated associations of esophagogastric junction (EGJ) metrics as an anti-reflux barrier with impedance-pH, endoscopic esophagitis, and lower esophageal sphincter (LES) metrics.


METHODS
We reviewed high-resolution manometry data from consecutive patients with gastroesophageal reflux disease (GERD) symptoms who underwent impedance-pH and endoscopy, and asymptomatic volunteers. The EGJ contractile integral (CI) was calculated as the mean contractile integral/second during three respiratory cycles. EGJ morphology was classified according to LES-crural diaphragm (CD) separation.


RESULTS
In total, 137 patients (65 male, age 55 years) and 23 (9 male, age 33 years) controls were enrolled. Twenty-five patients had erosive reflux disease (ERD), 16 had non-erosive reflux disease (NERD), 5 had reflux hypersensitivity, and 91 were not GERD. EGJ-CI were lower in patients with GERD (22.6 [13.8-29.2] mmHg cm) than non-GERD (50.3 [31-69.9] mmHg cm, P < 0.01) and controls (67 [26.7-78.7] mmHg cm). With an EGJ-CI cut-off value of 30 mmHg cm, the area under the curve was 0.814 (0.762-0.896), with 77.8% sensitivity and 81.7% specificity for the prediction of GERD. LES-CD separation was greatest in patients with ERD, followed the NERD, non-GERD, and controls. EGJ morphology type III was associated with a higher DeMeester score (7.9 [1.6-12.6]) than were type II (3.25 [0.9-5.975]) and I (1.75 [0.8-6.2]; P < 0.01). EGJ-CI values were lower in patients with GERD than in others in each EGJ morphology subgroup.


CONCLUSION
Esophagogastric junction contractile integral showed good diagnostic accuracy with high specificity in predicting GERD. LES-CD separation is associated with an increase in acid reflux, but EGJ-CI was associated more strongly with GERD than was EGJ morphology.
['Ham|Hyoju|H|', 'Cho|Yu Kyung|YK|', 'Lee|Han Hee|HH|', 'Yoon|Seung Bae|SB|', 'Lim|Chul-Hyun|CH|', 'Kim|Jin Su|JS|', 'Park|Jae Myung|JM|', 'Choi|Myung-Gyu|MG|']
D000328:Adult D000368:Aged D017097:Electric Impedance D016099:Endoscopy, Gastrointestinal D049630:Esophageal Sphincter, Lower D004943:Esophagogastric Junction D005260:Female D005764:Gastroesophageal Reflux D006801:Humans D006863:Hydrogen-Ion Concentration D008297:Male D008365:Manometry D008875:Middle Aged D012680:Sensitivity and Specificity
esophagogastric junction gastroesophageal reflux high resolution manometry