Esophagogastric junction morphology is associated with a positive impedance-pH monitoring in patients with GERD
S. Tolone, C. de Cassan, N. de Bortoli, S. Roman, F. Galeazzi, R. Salvador, E. Marabotto, M. Furnari, P. Zentilin, S. Marchi, R. Bardini, G. C. Sturniolo, V. Savarino and E. Savarino
Article first published online: 25 MAY 2015 | DOI: 10.1111/nmo.12606
Esophagogastric junction (EGJ) morphology can play an important role in defense mechanism against reflux. Defining EGJ morphology with high-resolution manometry (HRM) may be useful to predict an abnormal impedance-pH testing in GERD. This study aims to establish a correlation between EGJ subtypes and different reflux parameters, detected during impedance-pH monitoring in GERD patients. EGJ morphology is depicted at HRM by evaluating the position of lower esophageal sphincter (LES) and crural diaphragm (CD). EGJ subtypes are classified as: Type I, no separation detectable between LES and CD; Type II, presence of minimal separation (>1 and <2 cm) between LES and CD; Type III, presence of separation ≥2 cm. Reflux parameters determined at impedance-pH monitoring are total number of reflux, total esophageal acid exposure time (AET) and symptom-reflux events association analysis. Our findings demonstrated that a gradual and significant increase in terms of esophageal AET, total number of reflux episodes and positive reflux-symptom association are observed when the separation between LES and CD becomes wider (Type II and III EGJ morphology). EGJ morphology may be useful to estimate an abnormal impedance-pH testing in patients with reflux symptoms. However, reflux monitoring remains mandatory to confirm the diagnosis of GERD.