title: Esophagogastric junction contractile integral and morphology: Two high-resolution manometry metrics of the anti-reflux barrier.
abstract: OBJECTIVE
  We evaluated associations of esophagogastric junction (EGJ) metrics as an anti-reflux barrier with impedance-pH, endoscopic esophagitis, and lower esophageal sphincter (LES) metrics.
  
  
  METHODS
  We reviewed high-resolution manometry data from consecutive patients with gastroesophageal reflux disease (GERD) symptoms who underwent impedance-pH and endoscopy, and asymptomatic volunteers. The EGJ contractile integral (CI) was calculated as the mean contractile integral/second during three respiratory cycles. EGJ morphology was classified according to LES-crural diaphragm (CD) separation.
  
  
  RESULTS
  In total, 137 patients (65 male, age 55 years) and 23 (9 male, age 33 years) controls were enrolled. Twenty-five patients had erosive reflux disease (ERD), 16 had non-erosive reflux disease (NERD), 5 had reflux hypersensitivity, and 91 were not GERD. EGJ-CI were lower in patients with GERD (22.6 [13.8-29.2] mmHg cm) than non-GERD (50.3 [31-69.9] mmHg cm, P < 0.01) and controls (67 [26.7-78.7] mmHg cm). With an EGJ-CI cut-off value of 30 mmHg cm, the area under the curve was 0.814 (0.762-0.896), with 77.8% sensitivity and 81.7% specificity for the prediction of GERD. LES-CD separation was greatest in patients with ERD, followed the NERD, non-GERD, and controls. EGJ morphology type III was associated with a higher DeMeester score (7.9 [1.6-12.6]) than were type II (3.25 [0.9-5.975]) and I (1.75 [0.8-6.2]; P < 0.01). EGJ-CI values were lower in patients with GERD than in others in each EGJ morphology subgroup.
  
  
  CONCLUSIONS
  Esophagogastric junction contractile integral showed good diagnostic accuracy with high specificity in predicting GERD. LES-CD separation is associated with an increase in acid reflux, but EGJ-CI was associated more strongly with GERD than was EGJ morphology.
authors.affiliation: Department of Internal Medicine, The College of Medicine, The Catholic University of Korea, Seoul, Korea.
authors.forename: Hyoju
authors.initials: H
authors.lastname: Ham
authors.affiliation: Department of Internal Medicine, The College of Medicine, The Catholic University of Korea, Seoul, Korea.
authors.forename: Yu Kyung
authors.initials: YK
authors.lastname: Cho
authors.affiliation: Department of Internal Medicine, The College of Medicine, The Catholic University of Korea, Seoul, Korea.
authors.forename: Han Hee
authors.initials: HH
authors.lastname: Lee
authors.affiliation: Department of Internal Medicine, The College of Medicine, The Catholic University of Korea, Seoul, Korea.
authors.forename: Seung Bae
authors.initials: SB
authors.lastname: Yoon
authors.affiliation: Department of Internal Medicine, The College of Medicine, The Catholic University of Korea, Seoul, Korea.
authors.forename: Chul-Hyun
authors.initials: CH
authors.lastname: Lim
authors.affiliation: Department of Internal Medicine, The College of Medicine, The Catholic University of Korea, Seoul, Korea.
authors.forename: Jin Su
authors.initials: JS
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, The College of Medicine, The Catholic University of Korea, Seoul, Korea.
authors.forename: Jae Myung
authors.initials: JM
authors.lastname: Park
authors.affiliation: Department of Internal Medicine, The College of Medicine, The Catholic University of Korea, Seoul, Korea.
authors.forename: Myung-Gyu
authors.initials: MG
authors.lastname: Choi
mesh_terms: D000328:Adult; D000368:Aged; D017097:Electric Impedance; D016099:Endoscopy, Gastrointestinal; D049630:Esophageal Sphincter, Lower / Q000503:physiopathology; D004943:Esophagogastric Junction / Q000473:pathology* / Q000503:physiopathology*; D005260:Female; D005764:Gastroesophageal Reflux / Q000175:diagnosis*; D006801:Humans; D006863:Hydrogen-Ion Concentration; D008297:Male; D008365:Manometry / Q000379:methods*; D008875:Middle Aged; D012680:Sensitivity and Specificity
keywords: esophagogastric junction; gastroesophageal reflux; high resolution manometry