title: Interrogation of esophagogastric junction barrier function using the esophagogastric junction contractile integral: an observational cohort study.
abstract: The esophagogastric junction contractile integral (EGJ-CI), designed similar to distal contractile integral (DCI), has been proposed as a metric to evaluate EGJ barrier function. We determined normative values and evaluated EGJ-CI in predicting esophageal acid exposure time (AET) and symptomatic outcome in this observational cohort study. High-resolution manometry (HRM) studies were reviewed in 188 patients (55.2 ± 0.9 years, 64% female) undergoing ambulatory pH monitoring off therapy. Dominant symptoms and global symptom severity (GSS) were determined on questionnaires initially and upon follow-up. EGJ-CI was measured using the DCI tool placed across the EGJ and compared to normal controls (n = 21, 27.6 ± 0.6 years, 52% female). EGJ-CI was calculated both for a single respiratory cycle (SRC, in mmHg.cm.s) and corrected for respiratory cycle (CRC, mmHg.cm). Univariate and multivariate analyses determined the predictive potential of EGJ-CI in terms of AET and post-therapy GSS at follow-up, controlling for medical versus surgical therapy. Mean EGJ-CI values were significantly lower when AET was abnormal; EGJ-CI/SRC and EGJ-CI/CRC were 86% concordant (r = 0.84). Using receiver operating characteristic analysis, values below 121.8 mmHg.cm.s (EGJ-CI/SRC) and 39.3 mmHg.cm (EGJ-CI/CRC) predicted abnormal AET best (sensitivity 0.61 and 0.65, specificity 0.61 and 0.57, respectively). On univariate and multivariate analysis, the EGJ-CI discriminated normal from abnormal AET better than conventional LES parameters (P ≤ 0.02). After 2.7 ± 0.1 years follow-up, EGJ-CI below identified thresholds predicted better symptom response to antireflux surgery compared to medical therapy (P = 0.009). EGJ-CI is a novel HRM metric that has potential to complement or replace currently used basal LES and EGJ parameters.
authors.affiliation: Division of Gastroenterology, Washington University School of Medicine, St Louis, Missouri, USA.
authors.forename: P
authors.initials: P
authors.lastname: Gor
authors.affiliation: Division of Gastroenterology, Washington University School of Medicine, St Louis, Missouri, USA.
authors.forename: Y
authors.initials: Y
authors.lastname: Li
authors.affiliation: Division of Gastroenterology, Washington University School of Medicine, St Louis, Missouri, USA.
authors.forename: S
authors.initials: S
authors.lastname: Munigala
authors.affiliation: Division of Gastroenterology, Washington University School of Medicine, St Louis, Missouri, USA.
authors.forename: A
authors.initials: A
authors.lastname: Patel
authors.affiliation: Division of Gastroenterology, Washington University School of Medicine, St Louis, Missouri, USA.
authors.forename: A
authors.initials: A
authors.lastname: Bolkhir
authors.affiliation: Division of Gastroenterology, Washington University School of Medicine, St Louis, Missouri, USA. cprakash@wustl.edu.
authors.forename: C P
authors.initials: CP
authors.lastname: Gyawali
mesh_terms: D000328:Adult; D000465:Algorithms; D015331:Cohort Studies; D015154:Esophageal Motility Disorders / Q000175:diagnosis* / Q000503:physiopathology; D050782:Esophageal pH Monitoring; D004943:Esophagogastric Junction / Q000503:physiopathology*; D005260:Female; D006801:Humans; D008297:Male; D008365:Manometry; D008875:Middle Aged; D009119:Muscle Contraction; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity
keywords: esophagogastric junction; gastroesophageal reflux disease; high-resolution manometry