Predictive value of routine esophageal high-resolution manometry for gastro-esophageal reflux disease.
BACKGROUND
Using conventional manometry, gastro-esophageal reflux disease (GERD) was associated with a reduced lower esophageal sphincter (LES) pressure and impaired peristalsis. However, with a large overlap between GERD patients and controls, these findings are of limited clinical relevance. It is uncertain whether the more detailed information of high-resolution manometry (HRM) can discriminate GERD patients. Therefore, we aimed to determine to which extent HRM findings can predict GERD.


METHODS
HRM measurements in 69 patients with GERD and 40 healthy subjects were compared and the predictive value of HRM for the diagnosis of GERD was explored.


RESULTS
GERD patients had a significantly lower contraction amplitude (55 vs 64 mmHg; p = 0.045) and basal LES pressure (10 vs 13.2 mmHg; p = 0.034) than healthy controls. GERD patients more often had a hiatal hernia than healthy subjects (30% vs 7%; p = 0.005). Patients with reflux esophagitis had a lower DCI than patients without reflux esophagitis (558 vs 782 mmHg cm s; p = 0.045). No significant difference was seen in contractile front velocity, distal latency, number of peristaltic breaks, residual LES pressure and LES length. On multivariate logistic regression analysis, both esophagogastric junction type I (OR 4.971; 95% CI 1.33-18.59; p = 0.017) and mean wave amplitude (OR 0.95; 95% CI 0.90-0.98; p = 0.013) were found to be independent predictors of GERD. However, the sensitivity and specificity of these findings were low.


CONCLUSIONS
Hiatal hernia, low contraction amplitude and LES pressure are associated with GERD, but do not predict the disease with sufficient accuracy. Routine esophageal HRM can therefore not be used to distinguish GERD patients from healthy subjects.
Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, The Netherlands.
F B
FB
van Hoeij
Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, The Netherlands.
A J
AJ
Smout
Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, The Netherlands.
A J
AJ
Bredenoord
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004943:Esophagogastric Junction / Q000503:physiopathology*; D004947:Esophagus / Q000503:physiopathology*; D005260:Female; D005764:Gastroesophageal Reflux / Q000175:diagnosis* / Q000503:physiopathology; D006801:Humans; D008297:Male; D008365:Manometry; D008875:Middle Aged; D055815:Young Adult
esophageal motility; gastro-esophageal reflux disease; high-resolution manometry; lower esophageal sphincter