Characterizing reflux on high resolution esophageal manometry with impedance.

Area of Science:

• Gastroenterology
• Esophageal Physiology
• Reflux Monitoring

Background:

• Reflux at the esophagogastric junction (EGJ) is sometimes observed during high-resolution esophageal manometry with impedance (HREMI).
• The correlation between EGJ reflux detected by HREMI and findings from conventional esophageal reflux monitoring remains unclear.

Purpose of the Study:

• To determine the prevalence of esophagogastric junction (EGJ) reflux detected by high-resolution esophageal manometry with impedance (HREMI).
• To correlate EGJ reflux identified during HREMI with results from standard esophageal reflux monitoring studies.

Main Methods:

• Patients undergoing both HREMI and ambulatory reflux monitoring between July 2019 and February 2020 were included.
• Healthy volunteers also underwent HREMI for comparison.

Main Results:

• Pathologic reflux at the EGJ on HREMI (≥2 swallows) was identified in 20.5% of 229 patients.
• Patients with HREMI-detected reflux showed significantly more reflux events on multichannel intraluminal impedance-pH (MII-pH) monitoring compared to those without (63.5 vs. 42.1 events, p=0.01).
• Reflux on HREMI demonstrated good specificity (up to 91.4%) but low sensitivity (14.2%) for diagnosing GERD.

Conclusions:

• Approximately 20.5% of patients undergoing HREMI exhibit pathologic reflux at the EGJ.
• The presence of reflux during HREMI is associated with a higher likelihood of diagnosed GERD via ambulatory pH monitoring.
• HREMI is a specific but not highly sensitive tool for GERD detection.