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. 2017 Jan 30;23(1):27-33.
doi: 10.5056/jnm16008.

Esophagogastric Junction Contractility Integral Reflect the Anti-reflux Barrier Dysfunction in Patients with Gastroesophageal Reflux Disease

Chenxi Xie  1 , Jinhui Wang  1 , Yuwen Li  1 , Niandi Tan  1 , Yi Cui  1 , Minhu Chen  1 , Yinglian Xiao  1
Affiliations

Esophagogastric Junction Contractility Integral Reflect the Anti-reflux Barrier Dysfunction in Patients with Gastroesophageal Reflux Disease

Chenxi Xie et al. J Neurogastroenterol Motil. .

Abstract

Background/aims: Anti-reflux barrier dysfunction is one of the primary mechanisms in gastroesophageal reflux disease (GERD) pathogenesis. The esophagogastric junction contractile integral (EGJ-CI) is a new metric adopted to evaluate the EGJ contractility, which implies the antireflux barrier function. The aim of the current study was to validate this new metric in patients with GERD and its correlation with the esophageal acid exposure, as well as the efficacy of proton pump inhibitor treatment.

Methods: Ninety-eight patients with GERD and 21 healthy controls were included in the study. Upper endoscopy, high-resolution manometry (HRM) and 24-hour multichannel intraluminal impedance-pH monitoring were performed in all patients. Three respiration cycles were chosen at the initial HRM resting frame and the value computed with distal contractile integral tool was then divided by the duration of the cycles to yield EGJ-CI. All the patients were treated with esomeprazole 20 mg twice-daily for 8 weeks.

Results: EGJ-CI was lower in the patients with GERD than that of the controls (P < 0.05). For patients with GERD, EGJ-CI was lower in those with hiatal hernia (P < 0.05). The new metric correlated with esophageal acid exposure in the supine position (P < 0.05), and it also negatively correlated to the total reflux episodes (P < 0.05). There was no significant difference on EGJ-CI between patients with and without response to the esomeprazole treatment (P = 0.627).

Conclusions: EGJ-CI reflected the dysfunction of the anti-reflux barrier in patients with GERD, but it had little impact on the esomeprazole response.

Keywords: Esophagogastric junction; Gastroesophageal reflux disease; Hernia, hiatal; Manometry; Proton pump inhibitors.

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Figures

Figure 1
Figure 1
The calculation of esophagogastric junction distal contractile integral (EGJ-DCI). Three respiration cycles beginning at the inspiration are chosed by adding a swallow frame at baseline state. Using the isobaric contour, the barrier margins are setup at a pressure with 2 mmHg higher than the intragastric pressure. Then the value of EGJ-DCI can be obtained by using the DCI tool. (A) Changes of total esophageal pressure at rest and the yellow box shows region chose to calculate EGJ-DCI. (B) Calculation of EGJ-DCI using DCI tool.
Figure 2
Figure 2
The correlation of esophagogastric junction contractile integral (EGJ-CI) and other parameters. EGJ-CI correlated with integrated relaxation pressure (IRP), inspiratory EGJ pressure (EGJP-insp), and expiratory EGJ pressure (EGJP-exp) positively. The new metric correlated to the total reflux episodes and percentage of supine acid exposure time (AET%) negatively.
See this image and copyright information in PMC

References

    1. Gyawali CP. High resolution manometry: the Ray Clouse legacy. Neurogastroenterol Motil. 2012;24(suppl 1):2–4. doi: 10.1111/j.1365-2982.2011.01836.x. - DOI - PubMed
    1. Kahrilas PJ. Esophageal motor disorders in terms of high-resolution esophageal pressure topography: what has changed? Am J Gastroenterol. 2010;105:981–987. doi: 10.1038/ajg.2010.43. - DOI - PMC - PubMed
    1. Bredenoord AJ, Fox M, Kahrilas PJ, Pandolfino JE, Schwizer W, Smout AJ. Chicago classification criteria of esophageal motility disorders defined in high resolution esophageal pressure topography. Neurogastroenterol Motil. 2012;24(suppl 1):57–65. doi: 10.1111/j.1365-2982.2011.01834.x. - DOI - PMC - PubMed
    1. Nicodème F, Pipa-Muniz M, Khanna K, Kahrilas PJ, Pandolfino JE. Quantifying esophagogastric junction contractility with a novel HRM topographic metric, the EGJ-Contractile Integral: normative values and preliminary evaluation in PPI non-responders. Neurogastroenterol Motil. 2014;26:353–360. doi: 10.1111/nmo.12267. - DOI - PMC - PubMed
    1. Gor P, Li Y, Munigala S, Patel A, Bolkhir A, Gyawali CP. Interrogation of esophagogastric junction barrier function using the esophagogastric junction contractile integral: an observational cohort study. Dis Esophagus. 2016;29:820–828. doi: 10.1111/dote.12389. - DOI - PMC - PubMed

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