Basal lower esophageal sphincter pressure in gastroesophageal reflux disease: An ignored metric in high-resolution esophageal manometry

Jain, Mayank; Srinivas, M; Bawane, Piyush; Venkataraman, Jayanthi

doi:10.1007/s12664-018-0898-x

Cited by 10 publications

(9 citation statements)

References 18 publications

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“…In the same study, LES pressure (11.9 vs 16.6; P < .02) and IRP (5.7 vs 7.4; P < .01) were significantly lower, hernia size (1.7 vs 1.4 cm; P < .003) was significantly higher in pathological reflux group. [17] On the other hand, similar to the results of our study, some studies showed that hernia size was not related to esophageal motility. In the study conducted by Liu et al, it was reported that low LES resting pressure in patients with hernia caused esophagitis, and esophageal muscle dysfunction in patients without hernia could be the cause of GERD.…”

Section: Esophagitissupporting

confidence: 91%

Ineffective esophageal motility assessment in patients with and without pathological esophageal acid reflux

Paköz¹,

Sarı

Vatansever³

et al. 2021

Medicine

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Ineffective esophageal motility (IEM), defined as minor esophageal motility disorder, is also the most common esophageal motility disorder. The relationship between gastro-esophageal reflux disease is still controversial. Our aim in this study is to evaluate whether there are differences in terms of demographic, endoscopic, or motility findings between IEM patients with pathological esophageal acid reflux and physiological reflux. Patients diagnosed with IEM according to the Chicago classification v3 with high-resolution manometry (HRM) before acid monitoring constituted the study group of our investigation. The patients were divided into 2 groups as patients with pathological esophageal reflux and patients with physiological reflux according to 24-hour acid monitoring. Demographic data, endoscopic findings, and HRM findings were compared between 2 groups. A total of 62 patients who were diagnosed with IEM according to the Chicago classification v3 were included in the study. Patients in the physiological reflux group were 7 years younger on average than the pathological reflux group. Esophagitis rates were significantly higher in the pathological reflux group ( P = .033). Lower esophageal sphincter resting pressure, integrated relaxation pressure, and the presence of hernia were found to be similar in the 2 groups ( P = 392, P = 182, P = 657, respectively). The rate of severe IEM was also similar between the 2 groups ( P = .143). The fact that the physiological reflux patient group is younger may suggest that the IEM develops in the early period and then reflux accompanies the picture with advancing age.

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Section: Esophagitissupporting

confidence: 91%

Ineffective esophageal motility assessment in patients with and without pathological esophageal acid reflux

Paköz¹,

Sarı

Vatansever³

et al. 2021

Medicine

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“…These factors promote repetitive reflux episodes, abnormal pH monitoring, reflux-symptoms association, as well as increasing the likelihood of erosive esophagitis (Table 3). [14][15][16][17][18][19][20]…”

Section: Impaired Anti-reflux Barrier At the Esophagogastric Junctionmentioning

confidence: 99%

Concise Review: Applicability of High-resolution Manometry in Gastroesophageal Reflux Disease

Jandee

Keeratichananont

Tack

et al. 2022

J Neurogastroenterol Motil

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Manometry, particularly high-resolution manometry is the preferred diagnostic tool used to evaluate esophageal motor function. This investigation is strongly indicated in the setting of dysphagia, but is also useful in gastroesophageal reflux disease (GERD), especially in case of failure of conventional treatment to exclude alternative diagnoses and prior to anti-reflux surgery. Moreover, ineffective esophagogastric junction barrier function and esophageal motor dysfunction are pathophysiological mechanisms in GERD and can be identified by manometry. The recent international guidelines have positioned high-resolution manometry as an important part of functional diagnostic work up in GERD in order to identify the GERD phenotype to guide specific treatment. The proposed manometric identification and measurement is based on the Chicago classification version 4.0 adding with new established metrics for GERD evaluation.

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“…Here, we found a significant relationship between EPSIS results and LES pressure in HRM, which suggests that the anti-reflux barrier assessed by EPSIS can indirectly estimate the LES function. Based on the available literature, patients with pathological acid reflux had significantly lower basal LES pressure and lower IRP 16 . Previous reports have also shown that patients with hiatal hernia 17 and GERD symptoms 18 had lower basal LES pressure.…”

Section: Discussionmentioning

confidence: 99%

Association between endoscopic pressure study integrated system (EPSIS) and high-resolution manometry

et al. 2022

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Background and study aims The endoscopic pressure study integrated system (EPSIS), a novel diagnostic tool for gastroesophageal reflux disease (GERD), allows evaluation of the anti-reflux barrier using endoscopy by monitoring the intragastric pressure (IGP) during insufflation. In this study, we evaluated the association between EPSIS results and lower esophageal sphincter (LES) function measured by high-resolution manometry (HRM) to elucidate whether EPSIS can evaluate the LES function. Patients and methods A retrospective, single-center study of patients with GERD symptoms who underwent endoscopy, pH-impedance monitoring, EPSIS, and HRM was conducted. The primary outcome was basal LES pressure and the secondary outcomes were end-respiratory LES pressure and integrated relaxation pressure (IRP). As EPSIS parameters, the following were measured: 1) pressure difference (mmHg), the difference between maximum and basal IGP; and 2) pressure gradient (mmHg/s), calculated by dividing pressure difference by the insufflating time. Pressure difference < 4.7 mmHg or pressure gradient < 0.07 mmHg/s was defined as an EPSIS GERD pattern. Results Forty-seven patients (median age: 53 years, 37 female) were analyzed. Pressure difference and pressure gradient significantly correlated with basal LES pressure (ρ = 0.29; P = 0.04 and ρ = 0.29; P = 0.04). Patients with EPSIS GERD pattern showed significantly lower basal LES pressure [13.2 (4.8–26.6) vs 25.3 (10.4–66.7) mmHg, P = 0.002], lower end-respiratory LES pressure [8.5 (1.1–15.9) vs 15.5 (1.9–43.9) mmHg, P = 0.019] and lower IRP [5.9 (1.0–12.0) vs 9.8 (1.3–17.8) mmHg, P = 0.020]. Conclusions This study showed a close association between EPSIS results and LES pressures measured by HRM. This indicates that EPSIS can evaluate the LES function during endoscopy and endorse the role of EPSIS as a diagnostic tool for GERD.

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Basal lower esophageal sphincter pressure in gastroesophageal reflux disease: An ignored metric in high-resolution esophageal manometry

Cited by 10 publications

References 18 publications

Ineffective esophageal motility assessment in patients with and without pathological esophageal acid reflux

Ineffective esophageal motility assessment in patients with and without pathological esophageal acid reflux

Concise Review: Applicability of High-resolution Manometry in Gastroesophageal Reflux Disease

Association between endoscopic pressure study integrated system (EPSIS) and high-resolution manometry

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