title: Esophagogastric junction morphology is associated with a positive impedance-pH monitoring in patients with GERD.
abstract: BACKGROUND
  High-resolution manometry (HRM) provides information on esophagogastric junction (EGJ) morphology, distinguishing three different subtypes. Data on the correlation between EGJ subtypes and impedance-pH detected reflux patterns are lacking. We aimed to correlate the EGJ subtypes with impedance-pH findings in patients with reflux symptoms.
  
  
  METHODS
  Consecutive patients with suspected gastroesophageal reflux disease (GERD) were enrolled. All patients underwent HRM and impedance-pH testing off-therapy. EGJ was classified as: Type I, no separation between the lower esophageal sphincter (LES) and crural diaphragm (CD); Type II, minimal separation (>1 and <2 cm); Type III, ≥ 2 cm separation. We measured esophageal acid exposure time (AET), number of total reflux episodes and symptom association analysis.
  
  
  RESULTS
  We enrolled 130 consecutive patients and identified 46.2% Type I EGJ, 38.5% Type II, and 15.4% Type III patients. Type III subjects had a higher number of reflux episodes (61 vs 45, p < 0.03, vs 25, p < 0.001), a greater mean AET (12.4 vs 4.2, p < 0.02, vs 1.5, p < 0.001) and a greater positive symptom association (75% vs 72%, p = 0.732 vs 43.3%, p < 0.02) compared with Type II and I patients, respectively. Furthermore, Type II subjects showed statistically significant (overall p < 0.01) increased reflux when compared with Type I patients. Type III and II EGJ morphologies had a more frequent probability to show a positive multichannel intraluminal impedance pH monitoring than Type I (95% vs 84% vs 50%, p < 0.001).
  
  
  CONCLUSIONS
  Increasing separation between LES and CD can cause a gradual and significant increase in reflux. EGJ morphology may be useful to estimate an abnormal impedance-pH testing in GERD patients.
authors.affiliation: Division of Surgery, Department of Surgery, Second University of Naples, Naples, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Tolone
authors.affiliation: Division of Gastroenterology, Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy.
authors.forename: C
authors.initials: C
authors.lastname: de Cassan
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, University of Pisa, Pisa, Italy.
authors.forename: N
authors.initials: N
authors.lastname: de Bortoli
authors.affiliation: Digestive Physiology, Hospices Civils de Lyon, Lyon I University and Labtau, INSERM 1032, Lyon, France.
authors.forename: S
authors.initials: S
authors.lastname: Roman
authors.affiliation: Division of Gastroenterology, Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Galeazzi
authors.affiliation: U.O. Chirurgia Generale, Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy.
authors.forename: R
authors.initials: R
authors.lastname: Salvador
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, University of Genoa, Genoa, Italy.
authors.forename: E
authors.initials: E
authors.lastname: Marabotto
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, University of Genoa, Genoa, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Furnari
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, University of Genoa, Genoa, Italy.
authors.forename: P
authors.initials: P
authors.lastname: Zentilin
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, University of Pisa, Pisa, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Marchi
authors.affiliation: U.O. Chirurgia Generale, Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy.
authors.forename: R
authors.initials: R
authors.lastname: Bardini
authors.affiliation: Division of Gastroenterology, Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy.
authors.forename: G C
authors.initials: GC
authors.lastname: Sturniolo
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, University of Genoa, Genoa, Italy.
authors.forename: V
authors.initials: V
authors.lastname: Savarino
authors.affiliation: Division of Gastroenterology, Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy.
authors.forename: E
authors.initials: E
authors.lastname: Savarino
mesh_terms: D000328:Adult; D000368:Aged; D017097:Electric Impedance; D050782:Esophageal pH Monitoring; D004943:Esophagogastric Junction / Q000503:physiopathology*; D005260:Female; D005764:Gastroesophageal Reflux / Q000175:diagnosis* / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008365:Manometry; D008875:Middle Aged; D055815:Young Adult
keywords: GERD; esophagogastric junction; high-resolution manometry; impedance monitoring