title: High resolution manometry to detect transient lower oesophageal sphincter relaxations: diagnostic accuracy compared with perfused-sleeve manometry, and the definition of new detection criteria.
abstract: BACKGROUND
  Inhibition of transient lower oesophageal sphincter relaxations (tLESRs) has become one of the most relevant therapeutic objectives in patients with reflux symptoms resistant to proton pump inhibitors. tLESRs are currently detected by oesophageal perfused-sleeve manometry (PSM), but oesophageal high resolution manometry (HRM), which combines closely spaced pressure sensors and oesophageal pressure topography plots, may prove to be a better tool.
  
  
  OBJECTIVE
  To evaluate the efficacy, reproducibility and interobserver agreement of HRM for the detection of tLESRs, in comparison with PSM.
  
  
  METHODS
  Twenty-four healthy volunteers underwent HRM alone and on a separate occasion with PSM simultaneously. LES pressure was monitored for 1 h during fasting and 2 h postprandial. Criteria for tLESRs were defined by characterising spontaneous LES relaxation associated with common cavity and then applied to all spontaneous LES relaxations. Interobserver agreement and the rates of tLESRs detected by HRM and PSM were compared.
  
  
  RESULTS
  New HRM criteria for the detection of tLESRs have been established. A similar number of tLESRs were identified during the two HRM recordings (median per subject 15 and 13 (P = 0.07) and less with PSM (median per subject 11, P < 0.01). The overall concordance rate between the two procedures was substantial (kappa = 0.61). The interobserver agreement was almost perfect (kappa = 0.83) with HRM and only fair (kappa = 0.38) with PSM.
  
  
  CONCLUSIONS
  High resolution manometry is reproducible and more sensitive than PSM to detect tLESRs. HRM provides a better interobserver agreement. These results confirm that HRM is the gold standard for detecting tLESRs (NTC00931593).
authors.affiliation: Hospices Civils de Lyon, Edouard Herriot Hospital, Digestive Physiology and Université Claude Bernard Lyon 1, Lyon, France.
authors.forename: S
authors.initials: S
authors.lastname: Roman
authors.forename: F
authors.initials: F
authors.lastname: Zerbib
authors.forename: K
authors.initials: K
authors.lastname: Belhocine
authors.forename: S Bruley
authors.initials: SB
authors.lastname: des Varannes
authors.forename: F
authors.initials: F
authors.lastname: Mion
mesh_terms: D000328:Adult; D049630:Esophageal Sphincter, Lower / Q000502:physiology*; D005260:Female; D005764:Gastroesophageal Reflux / Q000175:diagnosis*; D006801:Humans; D008297:Male; D008365:Manometry / Q000379:methods*; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000295:instrumentation*; D009126:Muscle Relaxation / Q000502:physiology*; D009130:Muscle, Smooth / Q000502:physiology*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D055815:Young Adult