title: Impedance-high resolution manometry analysis of patients with nonerosive reflux disease.
abstract: OBJECTIVE
  Transient lower esophageal sphincter relaxations (TLESRs) contribute to episodes of reflux. Few studies have assessed the frequencies or compositions of TLESRs and reflux episodes in patients with reflux disease. We used combined high-resolution manometry and impedance monitoring to analyze reflux episodes and esophageal motility in these patients, compared with those of healthy individuals.
  
  
  METHODS
  We evaluated the frequency of TLESRs and the relationship between the reflux pattern and esophageal pressures during TLESRs in 14 patients with nonerosive reflux disease (NERD) and 11 controls. Study participants underwent combined high-resolution manometry and impedance monitoring before and 60 minutes after a solid and liquid meal. The diagnosis of NERD was confirmed by a 24-hour pH impedance test.
  
  
  RESULTS
  The frequency of TLESRs did not differ between patients with NERD and controls. In patients with NERD, TLESRs were associated more often with reflux episodes than in controls (93% ± 6% vs 66% ± 19%; P < .05). Patients with NERD had a higher percentage of pure liquid reflux episodes (33% ± 15% vs 10% ± 2%; P < .05), whereas controls had a higher percentage of mixed reflux episodes (45% ± 16% vs 67% ± 17% in patients with NERD; P < .05). Patients with NERD also had a higher percentage of reflux (liquid and mixed) associated with common cavities (74% ± 18% vs 50% ± 20% in controls; P < .05).
  
  
  CONCLUSIONS
  In contrast to previous studies, we found that TLESRs are associated more often with reflux in patients with NERD than control subjects; this association increases when only liquid and mixed refluxes are considered. These findings indicate that factors involved in the occurrence of reflux in patients with NERD during TLESRs are different from those in healthy subjects.
authors.affiliation: Department of Digestive Disease, University Campus Bio Medico, Rome, Italy. Electronic address: m.ribolsi@unicampus.it.
authors.forename: Mentore
authors.initials: M
authors.lastname: Ribolsi
authors.affiliation: Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, Discipline of Medicine, University of Adelaide, Adelaide, South Australia.
authors.forename: Richard H
authors.initials: RH
authors.lastname: Holloway
authors.affiliation: Department of Digestive Disease, University Campus Bio Medico, Rome, Italy.
authors.forename: Sara
authors.initials: S
authors.lastname: Emerenziani
authors.affiliation: Department of Digestive Disease, University Campus Bio Medico, Rome, Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Balestrieri
authors.affiliation: Department of Digestive Disease, University Campus Bio Medico, Rome, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Cicala
mesh_terms: D000328:Adult; D017097:Electric Impedance; D049630:Esophageal Sphincter, Lower / Q000503:physiopathology*; D049631:Esophageal Sphincter, Upper / Q000503:physiopathology*; D005260:Female; D005764:Gastroesophageal Reflux / Q000175:diagnosis* / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008365:Manometry; D008875:Middle Aged; D055815:Young Adult
keywords: AET; Acid; Esophagus; GERD; Gastroesophageal Junction; HRM; LES; MI; NERD; PPI; Pressure Gradient; Reflux Episodes; SAP; TLESR; TSPG; acid exposure time; gastroesophageal reflux disease; high-resolution manometry; lower esophageal sphincter; multichannel impedance; nonerosive reflux disease; proton pump inhibitor; symptom association probability; trans-sphincteric pressure gradient; transient lower esophageal sphincter relaxation