title: Esophagogastric junction contractility for clinical assessment in patients with GERD: a real added value?
abstract: BACKGROUND
  The role of esophagogastric junction contractile integral (EGJ-CI) as assessed by high-resolution manometry (HRM) is unclear. We aimed to correlate the EGJ-CI with impedance-pH findings in gastro-esophageal reflux disease (GERD) patients.
  
  
  METHODS
  Consecutive patients with GERD symptoms were enrolled. All patients underwent upper endoscopy, HRM, and impedance-pH testing. The EGJ-CI was calculated using the distal contractile integral tool box during three consecutive respiratory cycles. The value was then divided by the duration of these cycles. A value below 13 was considered as a defective EGJ-CI. We also assessed EGJ morphology, esophageal acid exposure time (AET), number of reflux episodes (NRE), and symptom association analysis (SAA). A positive impedance-pH monitoring was considered in case of abnormal AET and/or NRE and/or positive SAA.
  
  
  RESULTS
  Among 130 patients we enrolled, 91 had GERD (abnormal AET and/or elevated NRE and/or positive SAA) and 39 had functional heartburn (FH) (negative endoscopy, normal AET, normal NRE, and negative SAA). The GERD patients had a lower median value of EGJ-CI (11 [3.1-20.7] vs 22 [9.9-41], p < 0.02) compared to FH patients. Patients with a defective EGJ-CI had, more frequently, a positive impedance-pH monitoring or esophageal mucosal lesions at endoscopy (p < 0.05 and p < 0.05, respectively) than patients with a normal EGJ-CI. An EGJ-CI cut-off value of 5 mmHg cm yielded the optimal performance in identifying GERD at impedance-pH (sensitivity 89%-specificity 63%).
  
  
  CONCLUSIONS
  A defective EGJ-CI at HRM is clearly associated with evidence of GERD at impedance-pH monitoring. Evaluating EGJ-CI may be useful to predict an abnormal impedance-pH testing.
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 Internal Medicine, University of Pisa, Pisa, Italy.
authors.forename: N
authors.initials: N
authors.lastname: De Bortoli
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 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 Genoa, Genoa, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Bodini
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 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: V
authors.initials: V
authors.lastname: Savarino
authors.affiliation: Division of Surgery, Department of Surgery, Second University of Naples, Naples, Italy.
authors.forename: L
authors.initials: L
authors.lastname: Docimo
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; D004943:Esophagogastric Junction / Q000503:physiopathology*; D005260:Female; D005764:Gastroesophageal Reflux / Q000175:diagnosis*; D006801:Humans; D006863:Hydrogen-Ion Concentration; D008297:Male; D008365:Manometry; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000295:instrumentation / Q000379:methods*; D009119:Muscle Contraction / Q000502:physiology*; D011237:Predictive Value of Tests; D055815:Young Adult
keywords: EGJ contractile integral; GERD; esophagogastric junction; high-resolution manometry; impedance-pH monitoring