title: How useful is esophageal high resolution manometry in diagnosing gastroesophageal junction disruption: causes affecting this disruption and its relationship with manometric alterations and gastroesophageal reflux.
abstract: BACKGROUND
  High-resolution manometry (HRM) is a breakthrough in the morphological study of the gastroesophageal junction (GEJ) and its degrees of disruption.
  
  
  OBJECTIVE
  a) Assessment of risk factors involved in the disruption of the GEJ in patients with gastroesophageal reflux (GER) symptoms; b) the relationship between the type of GEJ and GER demonstrated by 24 hours pH-monitoring; and c) identification of the alterations in the manometric parameters related to the morphology of the GEJ.
  
  
  METHODS
  One hundred and fifteen patients with symptoms of GER studied with HRM and classified by the type of GEJ (type I: Normal; type II: Sliding; type III: Hiatal hernia). Twenty four hour pH-monitoring without proton pump inhibitors was performed in all of them. Epidemiological aspects, manometric parameters (Chicago 2012 classification) and the pH-monitoring results were evaluated.
  
  
  RESULTS
  Age (OR 1.033 [1.006-1.060]; p = 0.16), BMI (OR 1.097 [1.022-1.176]; p = 0. 01) and abdominal perimeter (OR 1.034 [1.005-1.063]; p = 0.0215) were independent risk factors for the GEJ type III (area under the curve 0.70). Disruption of the GEJ was associated with a lower resting pressure (p = 0.006), greater length (p < 0.001) and greater esophageal shortening (p < 0.001). Abnormal acidic reflux was found in the total period (p = 0.015), standing (p = 0.022) and supine (p = 0.001) in patients with GEJ type II and III with respect to type I.
  
  
  CONCLUSIONS
  Increased age, overweight and central obesity pose a higher risk of GEJ type III (hiatal hernia). The greater disruption of the GEJ is associated with lower resting pressure, esophageal shortening, and higher acid exposure in the pH-monitoring.
authors.forename: Constanza
authors.initials: C
authors.lastname: Ciriza-de-los-Ríos
authors.forename: Fernando
authors.initials: F
authors.lastname: Canga-Rodríguez-Valcárcel
authors.forename: Isabel
authors.initials: I
authors.lastname: Castel-de-Lucas
authors.forename: David
authors.initials: D
authors.lastname: Lora-Pablos
authors.forename: Javier
authors.initials: J
authors.lastname: de-la-Cruz-Bértolo
authors.forename: Gregorio
authors.initials: G
authors.lastname: Castellano-Tortajada
mesh_terms: D000368:Aged; D004943:Esophagogastric Junction / Q000503:physiopathology*; D004947:Esophagus / Q000503:physiopathology*; D005260:Female; D005764:Gastroesophageal Reflux / Q000175:diagnosis / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008365:Manometry / Q000379:methods*; D008875:Middle Aged; D012307:Risk Factors