J Neurogastroenterol Motil  https://doi.org/10.5056/jnm20139
Alteration in Integrated Relaxation Pressure During Successive Swallows in Subjects With Normal Manometry Versus Those With Esophagogastric Junction Outflow Obstruction
Abbinaya Elangovan, Fahmi Shibli, and Ronnie Fass*
The Esophageal and Swallowing Center, Division of Gastroenterology and Hepatology, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH, USA
Correspondence to: Ronnie Fass, MD, FACG
The Esophageal and Swallowing Center, Division of Gastroenterology and Hepatology, MetroHealth Medical Center, Case Western Reserve University, 2500 MetroHealth Dr, Cleveland, OH 44109, USA
Tel: +1-216-778-3145, Fax: +1- 216-778-2074, E-mail: Ronnie.fass@gmail.com
Received: June 18, 2020; Revised: October 30, 2020; Accepted: October 30, 2020; Published online: January 28, 2021.
© The Korean Society of Neurogastroenterology and Motility. All rights reserved.

Abstract
Background/Aims
Integrated relaxation pressure (IRP) is defined as the average minimum esophagogastric junction (EGJ) pressure for 4 seconds of relaxation (contiguous or noncontiguous) within 10 seconds of swallowing. The durability of IRP values during successive swallows in the supine position remains to be elucidated. The aim is to determine alteration in IRP values during successive swallows among subjects with normal esophageal manometry versus those with esophagogastric junction outflow obstruction (EGJOO).
Methods
Consecutive subjects, who underwent high-resolution esophageal manometry (HREM) were included in the study. Individuals had to have either normal manometry or EGJOO. A total of 10 wet swallows of 5 mL water were performed after an adaptation period of a minimum of 3 minutes. Mean IRP were analyzed for both subject groups for each individual swallow.
Results
Thirty-one patients with EGJOO and seventy patients with normal manometry were included. As expected, the median IRP was higher in EGJOO patients compared to those with normal HREM (mean: 23.92 vs 5.34, P < 0.001). The mean IRP of the last swallow was 40% lower than the mean IRP of the first swallow in the normal subjects (P = 0.015). In contrast, the difference in the mean IRP value in the EGJOO group between the first and the last swallow was 19% (P = 0.018).
Conclusions
This study demonstrated that there is a significant decline in the mean IRP during successive swallows in subjects with normal esophageal manometry and those with EGJOO, despite adequate adaptation periods. This decline in IRP was less pronounced in EGJOO.
Keywords: Manometry; Deglutition; Deglutition disorders; Esophageal sphincter, lower; Esophagogastric junction


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