Interrogation of esophagogastric junction barrier function using the esophagogastric junction contractile integral: an observational cohort study. Issue 7 (14th July 2015)

• Record Type: Journal Article
• Authors: Gor, P.; Li, Y.; Munigala, S.; Patel, A.; Bolkhir, A.; Gyawali, C. P.
• Is Part Of: Diseases of the esophagus. Volume 29:Issue 7(2016)
• Page Start: 820
• Page End: 828
• Publication Date: 2015-07-14
• Subjects: esophagogastric junction -- gastroesophageal reflux disease -- high‐resolution manometry; Esophagus -- Diseases -- Periodicals; 616.32
• DOI: 10.1111/dote.12389
• Languages: English
• ISSNs: 1120-8694

Abstract

Summary: The esophagogastric junction contractile integral (EGJ‐CI), designed similar to distal contractile integral (DCI), has been proposed as a metric to evaluate EGJ barrier function. We determined normative values and evaluated EGJ‐CI in predicting esophageal acid exposure time (AET) and symptomatic outcome in this observational cohort study. High‐resolution manometry (HRM) studies were reviewed in 188 patients (55.2 ± 0.9 years, 64% female) undergoing ambulatory pH monitoring off therapy. Dominant symptoms and global symptom severity (GSS) were determined on questionnaires initially and upon follow‐up. EGJ‐CI was measured using the DCI tool placed across the EGJ and compared to normal controls ( n = 21, 27.6 ± 0.6 years, 52% female). EGJ‐CI was calculated both for a single respiratory cycle (SRC, in mmHg.cm.s) and corrected for respiratory cycle (CRC, mmHg.cm). Univariate and multivariate analyses determined the predictive potential of EGJ‐CI in terms of AET and post‐therapy GSS at follow‐up, controlling for medical versus surgical therapy. Mean EGJ‐CI values were significantly lower when AET was abnormal; EGJ‐CI/SRC and EGJ‐CI/CRC were 86% concordant (r = 0.84). Using receiver operating characteristic analysis, values below 121.8 mmHg.cm.s (EGJ‐CI/SRC) and 39.3 mmHg.cm (EGJ‐CI/CRC) predicted abnormal AET best (sensitivity 0.61 and 0.65, specificity 0.61 and 0.57, respectively). On univariate and multivariate analysis, the EGJ‐CI discriminated normal from abnormal AET better than conventional LES parameters ( P ≤ 0.02). After 2.7 ± 0.1 years follow‐up, EGJ‐CI below identified thresholds predicted better symptom response to antireflux surgery compared to medical therapy ( P = 0.009). EGJ‐CI is a novel HRM metric that has potential to complement or replace currently used basal LES and EGJ parameters.