Esophagogastric junction contractile integral (EGJ-CI) quantifies changes in EGJ barrier function with surgical intervention.

Published

Journal Article

BACKGROUND: Esophagogastric junction contractile integral (EGJ-CI) assesses EGJ barrier function on esophageal high resolution manometry (HRM). We assessed EGJ-CI values in achalasia and gastroesophageal reflux disease (GERD) to determine if postoperative EGJ-CI changes reflected surgical intervention. METHODS: Twenty-one achalasia patients (42.8 ± 3.2 years, 62% F) with HRM before and after Heller myotomy (HM) and 68 GERD patients (53.9 ± 1.8 years, 66% F) undergoing antireflux surgery (ARS) were compared to 21 healthy controls (27.6 ± 0.6 years, 52% F). Esophagogastric junction contractile integral (mmHg.cm) was calculated using the distal contractile integral measurement across the EGJ, measured above the gastric baseline and corrected for respiration. Pre and postsurgical EGJ-CI and conventional lower esophageal sphincter pressure (LESP) metrics were compared within and between these groups using non-parametric tests. Correlation between EGJ-CI and conventional LESP metrics was assessed. KEY RESULTS: Baseline EGJ-CI was higher in achalasia compared to GERD (p < 0.001) or controls (p = 0.03). Esophagogastric junction contractile integral declined by 59.2% after HM in achalasia (p = 0.001), and increased by 26.3% after ARS in GERD (p = 0.005). End-expiratory and basal LESP decreased by 74.5% and 64.5% with HM, but increased by only 17.8% and 4.3% with ARS. Differences were noted between Dor vs Toupet fundoplication in achalasia (p = 0.007), and partial vs complete ARS in GERD (p = 0.03). Esophagogastric junction contractile integral correlated modestly with both end-expiratory and basal LESP (Pearson's r of 0.8 for all), but was less robust in GERD (0.7). CONCLUSIONS & INFERENCES: Esophagogastric junction contractile integral has clinical utility in assessing EGJ barrier function at baseline and after surgical intervention to the EGJ, and could complement conventional EGJ metrics.

Full Text

Duke Authors

Cited Authors

  • Wang, D; Patel, A; Mello, M; Shriver, A; Gyawali, CP

Published Date

  • May 2016

Published In

Volume / Issue

  • 28 / 5

Start / End Page

  • 639 - 646

PubMed ID

  • 26768087

Pubmed Central ID

  • 26768087

Electronic International Standard Serial Number (EISSN)

  • 1365-2982

Digital Object Identifier (DOI)

  • 10.1111/nmo.12757

Language

  • eng

Conference Location

  • England