Diagnostic significance of high resolution esophageal manometry combined with 24-hour pH impedance monitoring for gastroesophageal reflux disease

Abstract

Objective To investigate the effect of high resolution esophageal manometry combined with 24-hour esophageal multi-channel pH-impedance monitoring on baseline esophageal impedance in patients with gastroesophageal reflux disease (GERD). Methods A total of 150 patients with typical GERD symptoms admitted in our hospital from June 2017 to March 2019 were enrolled in this study. They were divided into reflux esophagitis group (RE, n=38), non-erosive reflux disease group (NERD, n=68) and functional heartburn group (FH, n=44). All subjects underwent routine gastroscopy, 24-hour esophageal pH-impedance monitoring and proton inhibitor (PPI) test. The BI values at 7, 9, 15 and 17 cm (a5 channel, a4 channel, a3 channel, a2 channel, a1 channel) above the lower esophageal sphincter were obtained respectively in the 3 groups, and the results were analyzed by SPSS22.0 statistical software. Results The distal contractile integral (DCI) and contractile front velocity (CFV) in the RE group and NERD group were significantly lower than those in FH group (P < 0.05). The BI values at the 5 channels of esophagus were obviously higher in the FH group than the NERD group and the RE group (P < 0.05). Receiver operating characteristic (ROC) curve analysis showed that the best cut-off value of esophageal BI of A5 channel in NERD group and FH group was 2 416 Ω, and the area under curve (AUC) was 0.92. And the sensitivity was 79.8% (95%CI: 0.40~0.87), specificity was 93.1% (95%CI: 0.48~0.94), positive predictive value was 98.3% (95%CI: 0.52~0.99), and negative predictive value was 48.2% (95%CI: 0.53~0.90). The acid exposure time (AET) was significantly longer in the NERD group [9.40%(4.46%~25.70%)] group and the RE group [10.60%(4.71%~24.29%)] when compared with the FH group [1.06%(0.20%~2.16%), P < 0.05], and obvious difference was seen in the former 2 groups (P < 0.05). The BI values in the NERD group and the RE group were negatively correlated with AET respectively (r=-0.651, -0.542, P < 0.05), but no such correlation was seen in the FH group (r=-0.402, P=0.240). Conclusion The results of high-resolution esophageal manometry combined with 24-hour multichannel pH impedance monitoring indicate that the BI value at 2 416 Ω of the distal esophagus is the best cut-off value for distinguishing NERD and FH. The degree of esophageal acid exposure is associated with the decrease of BI value of the esophagus in GERD patients.

Keywords

• esophageal manometry
• resistance monitoring
• baseline impedance
• gastroesophagus