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High-resolution Manometry Determinants of Refractoriness of Reflux Symptoms to Proton Pump Inhibitor Therapy

BACKGROUND/AIMS: Impaired esophageal motility and disrupted esophagogastric junction (EGJ) on high-resolution manometry (HRM) have been associated with increased reflux severity in gastroesophageal reflux disease (GERD) patients. However, there are limited data evaluating HRM parameters in proton pu...

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Autores principales: Ribolsi, Mentore, Savarino, Edoardo, Rogers, Benjamin, Rengarajan, Arvind, Coletta, Marco Della, Ghisa, Matteo, Cicala, Michele, Gyawali, C Prakash
Formato: Online Artículo Texto
Lenguaje:English
Publicado: The Korean Society of Neurogastroenterology and Motility 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7547194/
https://www.ncbi.nlm.nih.gov/pubmed/32122112
http://dx.doi.org/10.5056/jnm19153
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author Ribolsi, Mentore
Savarino, Edoardo
Rogers, Benjamin
Rengarajan, Arvind
Coletta, Marco Della
Ghisa, Matteo
Cicala, Michele
Gyawali, C Prakash
author_facet Ribolsi, Mentore
Savarino, Edoardo
Rogers, Benjamin
Rengarajan, Arvind
Coletta, Marco Della
Ghisa, Matteo
Cicala, Michele
Gyawali, C Prakash
author_sort Ribolsi, Mentore
collection PubMed
description BACKGROUND/AIMS: Impaired esophageal motility and disrupted esophagogastric junction (EGJ) on high-resolution manometry (HRM) have been associated with increased reflux severity in gastroesophageal reflux disease (GERD) patients. However, there are limited data evaluating HRM parameters in proton pump inhibitors (PPI) non-responders. METHODS: Clinical and endoscopic data, HRM and multichannel intraluminal impedance-pH studies performed of PPI therapy in patients with typical GERD symptoms were reviewed from 3 international centers. Frequency of GERD symptoms was assessed on and off PPI therapy in both non-responders (< 50% symptom improvement on PPI therapy) and responders. Rome IV definitions identified non-erosive reflux disease, reflux hypersensitivity, and functional heartburn. Univariate and multivariate analyses were performed to determine predictors of non-response. RESULTS: Of 204 patients, 105 were PPI non-responders and 99 were responders. Non-responders showed higher EGJ contractile integral values, and a lower frequency of type II and III EGJ morphology (P ≤ 0.03 for each comparison). Esophageal body diagnoses on HRM (fragmented peristalsis, ineffective esophageal motility, or absent peristalsis) did not predict non-response. On multivariate analysis, non-pathological acid exposure time (OR, 2.5; 95% CI, 1.2-5.0; P < 0.001), normal mean nocturnal baseline impedance values (OR, 2.7-2.4; 95% CI, 1.0-6.1; P < 0.05), normal EGJ contractile integral values (OR, 3; 95% CI, 1.3-7.4; P = 0.012), and presence of type I EGJ morphology (OR, 1.9; 95% CI, 1.0-3.4; P = 0.044) were associated with an unfavorable response to PPIs. CONCLUSIONS: Intact EGJ metrics on HRM complement normal reflux burden in predicting non-response to PPI therapy. HRM has value in the evaluation of PPI non-responders.
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spelling pubmed-75471942020-10-19 High-resolution Manometry Determinants of Refractoriness of Reflux Symptoms to Proton Pump Inhibitor Therapy Ribolsi, Mentore Savarino, Edoardo Rogers, Benjamin Rengarajan, Arvind Coletta, Marco Della Ghisa, Matteo Cicala, Michele Gyawali, C Prakash J Neurogastroenterol Motil Original Article BACKGROUND/AIMS: Impaired esophageal motility and disrupted esophagogastric junction (EGJ) on high-resolution manometry (HRM) have been associated with increased reflux severity in gastroesophageal reflux disease (GERD) patients. However, there are limited data evaluating HRM parameters in proton pump inhibitors (PPI) non-responders. METHODS: Clinical and endoscopic data, HRM and multichannel intraluminal impedance-pH studies performed of PPI therapy in patients with typical GERD symptoms were reviewed from 3 international centers. Frequency of GERD symptoms was assessed on and off PPI therapy in both non-responders (< 50% symptom improvement on PPI therapy) and responders. Rome IV definitions identified non-erosive reflux disease, reflux hypersensitivity, and functional heartburn. Univariate and multivariate analyses were performed to determine predictors of non-response. RESULTS: Of 204 patients, 105 were PPI non-responders and 99 were responders. Non-responders showed higher EGJ contractile integral values, and a lower frequency of type II and III EGJ morphology (P ≤ 0.03 for each comparison). Esophageal body diagnoses on HRM (fragmented peristalsis, ineffective esophageal motility, or absent peristalsis) did not predict non-response. On multivariate analysis, non-pathological acid exposure time (OR, 2.5; 95% CI, 1.2-5.0; P < 0.001), normal mean nocturnal baseline impedance values (OR, 2.7-2.4; 95% CI, 1.0-6.1; P < 0.05), normal EGJ contractile integral values (OR, 3; 95% CI, 1.3-7.4; P = 0.012), and presence of type I EGJ morphology (OR, 1.9; 95% CI, 1.0-3.4; P = 0.044) were associated with an unfavorable response to PPIs. CONCLUSIONS: Intact EGJ metrics on HRM complement normal reflux burden in predicting non-response to PPI therapy. HRM has value in the evaluation of PPI non-responders. The Korean Society of Neurogastroenterology and Motility 2020-09-30 2020-09-30 /pmc/articles/PMC7547194/ /pubmed/32122112 http://dx.doi.org/10.5056/jnm19153 Text en © 2020 The Korean Society of Neurogastroenterology and Motility This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Original Article
Ribolsi, Mentore
Savarino, Edoardo
Rogers, Benjamin
Rengarajan, Arvind
Coletta, Marco Della
Ghisa, Matteo
Cicala, Michele
Gyawali, C Prakash
High-resolution Manometry Determinants of Refractoriness of Reflux Symptoms to Proton Pump Inhibitor Therapy
title High-resolution Manometry Determinants of Refractoriness of Reflux Symptoms to Proton Pump Inhibitor Therapy
title_full High-resolution Manometry Determinants of Refractoriness of Reflux Symptoms to Proton Pump Inhibitor Therapy
title_fullStr High-resolution Manometry Determinants of Refractoriness of Reflux Symptoms to Proton Pump Inhibitor Therapy
title_full_unstemmed High-resolution Manometry Determinants of Refractoriness of Reflux Symptoms to Proton Pump Inhibitor Therapy
title_short High-resolution Manometry Determinants of Refractoriness of Reflux Symptoms to Proton Pump Inhibitor Therapy
title_sort high-resolution manometry determinants of refractoriness of reflux symptoms to proton pump inhibitor therapy
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7547194/
https://www.ncbi.nlm.nih.gov/pubmed/32122112
http://dx.doi.org/10.5056/jnm19153
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