Quantifying esophagogastric junction contractility with a novel HRM topographic metric, the EGJ‐Contractile Integral: normative values and preliminary evaluation in PPI non‐responders

Abstract

Background Despite its obvious pathophysiological relevance, the clinical utility of measures of esophagogastric junction (EGJ) contractility is unsubstantiated. High-resolution manometry (HRM) may improve upon this with its inherent ability to integrate the magnitude of contractility over time and length of the EGJ. This study aimed to develop a novel HRM metric summarizing EGJ contractility and test its ability distinguish among subgroups of proton pump inhibitor non-responders (PPI-NRs). Methods 75 normal controls and 88 PPI-NRs were studied. All underwent HRM. PPI-NRs underwent pH-impedance monitoring on PPI therapy scored in terms of acid exposure, number of reflux events, and reflux-symptom correlation and grouped as meeting All Criteria, Some Criteria, or No Criteria of abnormality. Control HRM studies were used to establish normal values for candidate EGJ contractility metrics, which were then compared in their ability to differentiate among PPI-NR subgroups. Results The EGJ contractile integral (EGJ-CI), a metric integrating contractility across the EGJ for three respiratory cycles, best distinguished the All Criteria PPI-NR subgroup from controls and other PPI-NR subgroups. Normal values (median, [IQR]) for this measure were 39 mmHg-cm [25–55 mmHg-cm]. The correlation between the EGJ-CI and a previously proposed metric, the lower esophageal sphincter-pressure integral, that used a fixed 10s time frame and an atmospheric as opposed to gastric pressure reference was weak. Conclusion Among HRM metrics tested, the EGJ-CI was best in distinguishing PPI-NRs meeting All Criteria of abnormality on pH-impedance testing. Future prospective studies are required to explore its utility in management of broader groups of GERD patients.

The Rome IV versus Rome III criteria for heartburn diagnosis: A comparative study

“…9 The collected parameters included the following: (1) esophagogastric junction (EGJ) parameters: EGJ morphology, lower esophageal sphincter (LES) length, integrated relaxation pressure (IRP), EGJ inspiratory pressure, EGJ expiratory pressure, and EGJ contractile integral (EGJ-CI), which was calculated according to Nicode`me et al; 10 (2) peristalsis parameters: distal latency (DL) and distal contractile integral (DCI). The MRS response was also evaluated according to Shaker et al, 11 and the MRS/liquid swallow ratios were calculated for the DCI.…”

Esophagogastric Junction Contractility Integral Reflect the Anti-reflux Barrier Dysfunction in Patients with Gastroesophageal Reflux Disease

“…So it is necessary to develop some new metrics to quantify the barrier function at rest. Recently a new parameter, EGJ contractile integral (EGJ-CI) was developed by Nicodème et al 4 to evaluate the EGJ function.…”

“…1,2 Integrated relaxation pressure (IRP), expiratory EGJ pressure (EGJP-exp), and inspiratory EGJ pressure (EGJP-insp) are the metrics commonly used to evaluate the anti-reflux barrier function, 3,4 but all of them have some shortcomings. IRP indicates the nadir EGJ pressure after deglutition and helps to exclude the outflow obstruction in EGJ.…”

What Is the Impact of High-Resolution Manometry in the Functional Diagnostic Workup of Gastroesophageal Reflux Disease

“…Thus, in addition to the classification of EGJ morphology as described above, the Chicago Classification v3.0 presents the LES pressure integral (LES-PI) and the EGJ contractile integral (EGJ-CI) as new HRM measures of EGJ contractility [6,16,17]. As shown in figure 3, the LES-PI integrates EGJ pressure data from a 10-s window and is referenced to atmospheric pressure [16] (fig.…”

“…As shown in figure 3, the LES-PI integrates EGJ pressure data from a 10-s window and is referenced to atmospheric pressure [16] (fig. 3A), and the EGJ-CI assesses EGJ contractility during 3 consecutive respiratory cycles and is referenced to intragastric pressure [17] (fig. 3B).…”