부산대학교 도서관

Background Etiology of gastro-esophageal reflux disease ( GERD) is multifactorial, but incompetence of the esophago-gastric junction ( EGJ) appears to be of crucial importance. Established manometric parameters for assessment of EGJ barrier function are sub-optimal, potentially because they reflect only a very brief (up to 30 seconds), not necessarily representative period. This prospective, case-control study tested the performance of novel, high-resolution manometry ( HRM) parameters of EGJ function in the assessment of GERD. Methods Patients with reflux symptoms and healthy controls ( HC) underwent standard HRM and 24-hour pH±impedance measurements. EGJ morphology, lower esophageal sphincter pressure integral ( LES- PI), EGJ contractile integral ( EGJ- CI) were compared with total- EGJ- CI, a novel parameter summarizing EGJ barrier function during the entire HRM protocol. Esophageal acid exposure ≥4.2%/24 h ( A-Reflux-pos) or ≥73 reflux episodes in 24 hours ( V-Reflux-pos) were considered pathological. Key Results Sixty five HC and 452 patients completed HRM, 380 (84%) patients underwent ambulatory reflux-monitoring. LES- PI, EGJ- CI and total- EGJ- CI correlated with EGJ morphology subtypes (all P<.00001). Only total- EGJ- CI was consistently lower in A-Reflux-pos and V-Reflux-pos subjects compared with HC and patients without GERD. Total- EGJ- CI was also the single best parameter for prediction of pathological reflux (optimal cut-off 47 mmHg cm, AUC 0.746, P<.0001). This cut-off value, approximately 1 SD below the mean normal value, showed modest sensitivity 54% and positive predictive value 46%, but good specificity 85% and negative predictive value 89% for GERD diagnosis. Conclusion & Inferences Total EGJ- CI, a new metric that summarizes EGJ contractility over time, allows an improved assessment of EGJ barrier function. Pathological reflux is unlikely if this metric is within the upper two-thirds of the normal range. [ABSTRACT FROM AUTHOR]