title: Validation of criteria for the definition of transient lower esophageal sphincter relaxations using high-resolution manometry.
abstract: BACKGROUND
  Criteria for transient lower esophageal sphincter relaxations (TLESRs) are well-defined for Dentsleeve manometry. As high-resolution manometry (HRM) is now the gold standard to assess esophageal motility, our aim was to propose a consensus definition of TLESRs using HRM.
  
  
  METHODS
  Postprandial esophageal HRM combined with impedance was performed in 10 patients with gastroesophageal reflux disease. Transient lower esophageal sphincter relaxations identification was performed by 17 experts using a Delphi process. Four investigators then characterized TLESR candidates that achieved 100% agreement (TLESR events) and those that achieved less than 25% agreement (non-events) after the third round. Logistic regression and decision tree analysis were used to define optimal diagnostic criteria.
  
  
  RESULTS
  All diagnostic criteria were more frequently encountered in the 57 TLESR events than in the 52 non-events. Crural diaphragm (CD) inhibition and LES relaxation duration >10 seconds had the highest predictive value to identify TLESR. Based on decision tree analysis, reflux on impedance, esophageal shortening, common cavity, upper esophageal sphincter relaxation without swallow and secondary peristalsis were alternate diagnostic criteria.
  
  
  CONCLUSIONS
  Using HRM, TLESR might be defined as LES relaxation occurring in absence of swallowing, lasting more than 10 seconds and associated with CD inhibition.
authors.affiliation: Digestive Physiology, Hospices Civils de Lyon, and Lyon I University, Lyon, France.|Inserm U1032, LabTAU, Lyon, France.
authors.forename: S
authors.initials: S
authors.lastname: Roman
authors.affiliation: Gastroenterology and Hepatology, Royal Adelaid Hospital, Adelaide, SA, Australia.
authors.forename: R
authors.initials: R
authors.lastname: Holloway
authors.affiliation: Department of Internal Medicine, Israelitic Hospital, University of Hamburg, Hamburg, Germany.
authors.forename: J
authors.initials: J
authors.lastname: Keller
authors.affiliation: Department of Surgery, Escola Paulista de Medicina, Federal University of Sao Paulo, Sao Paulo, Brazil.
authors.forename: F
authors.initials: F
authors.lastname: Herbella
authors.affiliation: Gastroenterology, CHU Bordeaux and Bordeaux II University, Bordeaux, France.
authors.forename: F
authors.initials: F
authors.lastname: Zerbib
authors.affiliation: Department of Gastroenterology and Hepatology, The First affiliated Hospital, Sen Yat-sen University, Guangzhou, China.
authors.forename: Y
authors.initials: Y
authors.lastname: Xiao
authors.affiliation: Hospices Civils de Lyon, Pôle Information Médicale Evaluation Recherche, Unité de recherche clinique, Lyon, France.
authors.forename: L
authors.initials: L
authors.lastname: Bernard
authors.affiliation: Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: A J
authors.initials: AJ
authors.lastname: Bredenoord
authors.affiliation: Institut des Maladies de l'Appareil Digestif, CHU Nantes and Nantes University, Nantes, France.
authors.forename: S
authors.initials: S
authors.lastname: Bruley des Varannes
authors.affiliation: Gastroenterology and Hepatology, Royal Adelaid Hospital, Adelaide, SA, Australia.
authors.forename: M
authors.initials: M
authors.lastname: Chen
authors.affiliation: iDigest Clinic and Laboratory for Disorders of GI Motility and Function, Division of Gastroenterology, University Hospital Zurich, Zurich, Switzerland.
authors.forename: M
authors.initials: M
authors.lastname: Fox
authors.affiliation: Division of Gasotrenterology, Department of Medicine, Northwestern University, Chicago, IL, USA.
authors.forename: P J
authors.initials: PJ
authors.lastname: Kahrilas
authors.affiliation: Division of Gastroenterology, Department of Medicine, University of California San Diego, San Diego, CA, USA.
authors.forename: R K
authors.initials: RK
authors.lastname: Mittal
authors.affiliation: Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.|Department of Pathophysiology and Transplantation, Università degli Studi, Milan, Italy.
authors.forename: R
authors.initials: R
authors.lastname: Penagini
authors.affiliation: Division of Gastroenterology, Department of Surgical, Oncological and Gastroenterological Sciences, University of Padua, Padua, Italy.
authors.forename: E
authors.initials: E
authors.lastname: Savarino
authors.affiliation: Center for Digestive Diseases, Bart's and the London School and Dentistry, London, UK.
authors.forename: D
authors.initials: D
authors.lastname: Sifrim
authors.affiliation: Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, China.
authors.forename: J
authors.initials: J
authors.lastname: Wu
authors.affiliation: Hospices Civils de Lyon, Pôle Information Médicale Evaluation Recherche, Unité de recherche clinique, Lyon, France.
authors.forename: E
authors.initials: E
authors.lastname: Decullier
authors.affiliation: Division of Gasotrenterology, Department of Medicine, Northwestern University, Chicago, IL, USA.
authors.forename: J E
authors.initials: JE
authors.lastname: Pandolfino
authors.affiliation: Digestive Physiology, Hospices Civils de Lyon, and Lyon I University, Lyon, France.|Inserm U1032, LabTAU, Lyon, France.
authors.forename: F
authors.initials: F
authors.lastname: Mion
mesh_terms: D000328:Adult; D000368:Aged; D003679:Deglutition / Q000502:physiology*; D049630:Esophageal Sphincter, Lower / Q000502:physiology*; D005260:Female; D005764:Gastroesophageal Reflux / Q000175:diagnosis* / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008365:Manometry / Q000379:methods / Q000592:standards*; D008875:Middle Aged; D009126:Muscle Relaxation / Q000502:physiology*; D015203:Reproducibility of Results
keywords: consensus; gastroesophageal reflux disease; high-resolution manometry; transient lower esophageal sphincter relaxation