Esophageal contractile segment impedance from high-resolution impedance manometry correlates with mean nocturnal baseline impedance and acid exposure time from 24-hour pH-impedance monitoring

2020 ◽  
Vol 33 (12) ◽  
Author(s):  
Anthony Horton ◽  
Shai Posner ◽  
Brian Sullivan ◽  
Jennifer Cornejo ◽  
Andrea Davis ◽  
...  

Summary Esophageal baseline impedance (BI) acquired during esophageal contraction (contractile segment impedance [CSI]) is proposed to improve BI accuracy in gastroesophageal reflux disease (GERD). We evaluated associations between CSI and conventional and novel GERD metrics. We analyzed high-resolution impedance manometry (HRIM) and ambulatory pH-impedance studies from 51 patients (58.6 ± 1.5 years; 26% F) with GERD symptoms studied off antisecretory therapy. Patients with achalasia or absent contractility were excluded. CSI (averaged across 10 swallows) and BI-HRIM (from the resting landmark phase) were acquired from the distal impedance sensors (distal sensor and 5 cm above the lower esophageal sphincter). Acid exposure time (AET) and mean nocturnal baseline impedance (MNBI) were calculated. Associations between CSI, BI-HRIM, MNBI, and AET were evaluated using correlation (Pearson) and receiver operating characteristic (ROC) analysis. Presenting symptoms included heartburn (67%), regurgitation (12%), cough (12%), and chest pain (10%). CSI-distal and CSI-5 each correlated with BI-HRIM, AET, and distal MNBI. Associations with AET were numerically stronger for CSI-distal (r = −0.46) and BI-HRIM-distal (r = −0.44) than CSI-5 (r = −0.33), BI-HRIM-5 (r = −0.28), or distal MNBI (r < −0.36). When compared to AET <4%, patients with AET >6% had significantly lower CSI-distal and BI-HRIM-distal values but not CSI-5, BI-HRIM-5, or MNBI. ROC areas under the curve for AET >6% were numerically higher for CSI-distal (0.81) than BI-HRIM-distal (0.77), distal MNBI (0.68–0.75), CSI-5 (0.68), or BI-HRIM-5 (0.68). CSI from HRIM studies inversely correlates with pathologic AET and has potential to augment the evaluation of GERD.

2020 ◽  
Vol 52 (4) ◽  
pp. 414-419
Author(s):  
Daniele Mandolesi ◽  
Patrizia Schiavon ◽  
Alexandros Ioannou ◽  
Michela Mancini ◽  
Maria Chiara Cimatti ◽  
...  

2017 ◽  
Vol 152 (5) ◽  
pp. S652-S653
Author(s):  
Leonardo Frazzoni ◽  
Marzio Frazzoni ◽  
Nicola de Bortoli ◽  
Salvatore Tolone ◽  
Manuele Furnari ◽  
...  

2020 ◽  
Vol 18 (3) ◽  
pp. 589-595 ◽  
Author(s):  
Arvind Rengarajan ◽  
Edoardo Savarino ◽  
Marco Della Coletta ◽  
Matteo Ghisa ◽  
Amit Patel ◽  
...  

2020 ◽  
pp. 155335062095503
Author(s):  
Brittany L. Kothari ◽  
Andrew J. Borgert ◽  
Kara J. Kallies ◽  
Shanu N. Kothari

Background. Objective measures including the DeMeester score, lower esophageal sphincter (LES) pressure, acid exposure time, and body mass index (BMI) are used to determine gastroesophageal reflux disease (GERD) severity and eligibility for various antireflux surgical procedures. The GERD Health-Related Quality of Life (GERD-HRQL) survey is widely used to evaluate patients’ subjective severity of symptoms and GERD-related quality of life. The purpose of this project was to identify whether or not the subjective measure (GERD-HRQL) correlated with objective measures (DeMeester score, LES, acid exposure time, and BMI) of GERD severity. Methods. A retrospective review of the medical records of patients who underwent antireflux surgery from 2013-2018 was completed. Patients’ GERD severity was measured preoperatively and postoperatively using the GERD-HRQL. Statistical analysis included the calculation of Spearman correlation coefficients, Wilcoxon rank sum, sign, and chi-square tests. Results. 151 patients were included in the study; 64% were female. The mean age and BMI were 54.6 ± 14.6 years and 30.1 ± 4.1 kg/m2, respectively. The mean preoperative DeMeester score was 43.1 ± 36.1, LES pressure was 19.9 ± 18.4 mmHg, and acid exposure time was 11.4 ± 9.6. Mean GERD-HRQL scores decreased from 27.3 ± 9.2 preoperative to 5.3 ± 4.5 postoperative; P < .0001. Preoperative GERD-HRQL scores were not correlated with the DeMeester score ( r = .11; P = .389), LES pressure ( r = −.20; P = .089), acid exposure time ( r = .05; P = .755), BMI ( r = .10; P = .329), or age ( r = −.16; P = .118). Conclusions. Total GERD-HRQL scores significantly decreased from pre- to postoperative. There was no correlation between subjective and objective GERD scoring. These data indicate the need for both physiologic evaluation and subjective assessment of patient symptoms during preoperative workup. There is a need for a contemporary, validated GERD questionnaire that correlates with objective pH testing.


2020 ◽  
Vol 158 (6) ◽  
pp. S-1069
Author(s):  
Sirish Rao ◽  
Kalyana Nandipati ◽  
Ryan W. Walters ◽  
Subhash Chandra

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