J Neurogastroenterol Motil  https://doi.org/10.5056/jnm20158
Patients With Definite and Inconclusive Evidence of Reflux According to Lyon Consensus Display Similar Motility and Esophagogastric Junction Characteristics
Mentore Ribolsi1*, Edoardo Savarino2, Benjamin Rogers3, Arvind Rengarajan3, Marco Della Coletta2, Matteo Ghisa2, Michele Cicala1, Chandra Prakash Gyawali3
1Unit of Gastroenterology, Campus Bio Medico University, Rome, Italy; 2Division of Gastroenterology, Department of Surgical, Oncological and Gastroenterological Sciences, University of Padua, Padua, Italy; 3Division of Gastroenterology, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
Correspondence to: Mentore Ribolsi, MD
Dipartimento di Malattie dell’Apparato Digerente, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo 200 – 00128, Rome, Italy
Tel: +39-06-225411, Fax: +39-06-225411638, E-mail: m.ribolsi@unicampus.it
Received: July 13, 2020; Revised: November 13, 2020; Accepted: November 17, 2020; Published online: May 28, 2021
© The Korean Society of Neurogastroenterology and Motility. All rights reserved.

Abstract
Background/Aims
The role of esophageal high-resolution manometry (HRM) within Lyon consensus phenotypes, especially patients with inconclusive gastroesophageal reflux disease (GERD) evidence, has not been fully investigated. In this multicenter, observational study we aim to compare HRM parameters in patients with GERD stratified according to the Lyon consensus.
Methods
Clinical and endoscopic data, HRM and multichannel intraluminal impedance-pH (MII-pH) studies performed off proton pump inhibitor therapy in patients with esophageal GERD symptoms were reviewed. Lyon consensus criteria identified pathological GERD, reflux hypersensitivity, functional heartburn, and inconclusive GERD. Patients, with inconclusive GERD were further subdivided into 2 groups based on total reflux numbers (≤ 80 or > 80 reflux episodes) during the MII-pH recording time.
Results
A total of 264 patients formed the study cohort. Pathological GERD and inconclusive GERD patients were associated with higher numbers of reflux episodes, lower mean nocturnal baseline impedance (MNBI) values, and a higher proportion of patients with pathologic MNBI compared to functional heartburn (P < 0.05 for each comparison). On multivariate analysis, pathological GERD and inconclusive GERD patients, both with ≤ 80 or > 80 reflux episodes, were significantly associated with pathologic esophagogastric junction contractile integral values and with presence of hiatus hernia (type 2/3 esophagogastric junction). Patients with inconclusive GERD and > 80 reflux episodes were significantly associated with fragmented peristalsis and ineffective esophageal motility whilst inconclusive GERD with ≤ 80 reflux episodes were significantly associated with fragmented peristalsis.
Conclusion
Esophageal motor parameters on HRM are similar between pathologic and inconclusive GERD according to the Lyon consensus.
Keywords: Esophagitis, peptic; Gastroesophageal reflux; Heartburn; Manometry


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