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

Journal of Neurogastroenterology and Motility 2020년 26권 4호 p.447 ~ 454
Ribolsi Mentore, Savarino Edoardo, Rogers Benjamin, Rengarajan Arvind, Coletta Marco Della, Ghisa Matteo, Cicala Michele, Gyawali C. Prakash,
소속 상세정보
 ( Ribolsi Mentore ) - Campus Bio-Medico University Unit of Gastroenterology
 ( Savarino Edoardo ) - University of Padua Department of Surgical, Oncological and Gastroenterological Sciences
 ( Rogers Benjamin ) - Washington University School of Medicine Department of Medicine
 ( Rengarajan Arvind ) - Washington University School of Medicine Department of Medicine
 ( Coletta Marco Della ) - University of Padua Department of Surgical, Oncological and Gastroenterological Sciences
 ( Ghisa Matteo ) - University of Padua Department of Surgical, Oncological and Gastroenterological Sciences
 ( Cicala Michele ) - Campus Bio-Medico University Unit of Gastroenterology
 ( Gyawali C. Prakash ) - Washington University School of Medicine Department of Medicine

Abstract


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.

키워드

Esophagogastric junction; Gastroesophageal reflux; Heartburn; Manometry; Proton pump inhibitors

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