Predictive value of routine esophageal high‐resolution manometry for gastro‐esophageal reflux disease

• Published in: Neurogastroenterology and motility 2015-07, Vol.27 (7), p.963-970
• Main Authors: Hoeij, F. B., Smout, A. J., Bredenoord, A. J.
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; esophageal motility; Esophagogastric Junction - physiopathology; Esophagus - physiopathology; Female; Gastroesophageal Reflux - diagnosis; Gastroesophageal Reflux - physiopathology; gastro‐esophageal reflux disease; high‐resolution manometry; Humans; lower esophageal sphincter; Male; Manometry; Middle Aged; Young Adult
• ISSN: 1350-1925; 1365-2982
• DOI: 10.1111/nmo.12570

Background Using conventional manometry, gastro‐esophageal reflux disease (GERD) was associated with a reduced lower esophageal sphincter (LES) pressure and impaired peristalsis. However, with a large overlap between GERD patients and controls, these findings are of limited clinical relevance. It is uncertain whether the more detailed information of high‐resolution manometry (HRM) can discriminate GERD patients. Therefore, we aimed to determine to which extent HRM findings can predict GERD. Methods HRM measurements in 69 patients with GERD and 40 healthy subjects were compared and the predictive value of HRM for the diagnosis of GERD was explored. Key Results GERD patients had a significantly lower contraction amplitude (55 vs 64 mmHg; p = 0.045) and basal LES pressure (10 vs 13.2 mmHg; p = 0.034) than healthy controls. GERD patients more often had a hiatal hernia than healthy subjects (30% vs 7%; p = 0.005). Patients with reflux esophagitis had a lower DCI than patients without reflux esophagitis (558 vs 782 mmHg cm s; p = 0.045). No significant difference was seen in contractile front velocity, distal latency, number of peristaltic breaks, residual LES pressure and LES length. On multivariate logistic regression analysis, both esophagogastric junction type I (OR 4.971; 95% CI 1.33–18.59; p = 0.017) and mean wave amplitude (OR 0.95; 95% CI 0.90–0.98; p = 0.013) were found to be independent predictors of GERD. However, the sensitivity and specificity of these findings were low. Conclusions & Inferences Hiatal hernia, low contraction amplitude and LES pressure are associated with GERD, but do not predict the disease with sufficient accuracy. Routine esophageal HRM can therefore not be used to distinguish GERD patients from healthy subjects. This paper discusses the relationship between manometric abnormalities and reflux disease (GERD). Hiatal hernia, low contraction amplitude and LES pressure are associated with GERD, but do not predict the disease with sufficient accuracy. Routine esophageal HRM can therefore not be used to distinguish GERD patients from healthy subjects.