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Interrogation of esophagogastric junction barrier function using the esophagogastric junction contractile integral: an observational cohort study.

Publication ,  Journal Article
Gor, P; Li, Y; Munigala, S; Patel, A; Bolkhir, A; Gyawali, CP
Published in: Dis Esophagus
October 2016

The esophagogastric junction contractile integral (EGJ-CI), designed similar to distal contractile integral (DCI), has been proposed as a metric to evaluate EGJ barrier function. We determined normative values and evaluated EGJ-CI in predicting esophageal acid exposure time (AET) and symptomatic outcome in this observational cohort study. High-resolution manometry (HRM) studies were reviewed in 188 patients (55.2 ± 0.9 years, 64% female) undergoing ambulatory pH monitoring off therapy. Dominant symptoms and global symptom severity (GSS) were determined on questionnaires initially and upon follow-up. EGJ-CI was measured using the DCI tool placed across the EGJ and compared to normal controls (n = 21, 27.6 ± 0.6 years, 52% female). EGJ-CI was calculated both for a single respiratory cycle (SRC, in mmHg.cm.s) and corrected for respiratory cycle (CRC, mmHg.cm). Univariate and multivariate analyses determined the predictive potential of EGJ-CI in terms of AET and post-therapy GSS at follow-up, controlling for medical versus surgical therapy. Mean EGJ-CI values were significantly lower when AET was abnormal; EGJ-CI/SRC and EGJ-CI/CRC were 86% concordant (r = 0.84). Using receiver operating characteristic analysis, values below 121.8 mmHg.cm.s (EGJ-CI/SRC) and 39.3 mmHg.cm (EGJ-CI/CRC) predicted abnormal AET best (sensitivity 0.61 and 0.65, specificity 0.61 and 0.57, respectively). On univariate and multivariate analysis, the EGJ-CI discriminated normal from abnormal AET better than conventional LES parameters (P ≤ 0.02). After 2.7 ± 0.1 years follow-up, EGJ-CI below identified thresholds predicted better symptom response to antireflux surgery compared to medical therapy (P = 0.009). EGJ-CI is a novel HRM metric that has potential to complement or replace currently used basal LES and EGJ parameters.

Duke Scholars

Published In

Dis Esophagus

DOI

EISSN

1442-2050

Publication Date

October 2016

Volume

29

Issue

7

Start / End Page

820 / 828

Location

United States

Related Subject Headings

  • Sensitivity and Specificity
  • Predictive Value of Tests
  • Muscle Contraction
  • Middle Aged
  • Manometry
  • Male
  • Humans
  • Gastroenterology & Hepatology
  • Female
  • Esophagogastric Junction
 

Citation

APA
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ICMJE
MLA
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Gor, P., Li, Y., Munigala, S., Patel, A., Bolkhir, A., & Gyawali, C. P. (2016). Interrogation of esophagogastric junction barrier function using the esophagogastric junction contractile integral: an observational cohort study. Dis Esophagus, 29(7), 820–828. https://doi.org/10.1111/dote.12389
Gor, P., Y. Li, S. Munigala, A. Patel, A. Bolkhir, and C. P. Gyawali. “Interrogation of esophagogastric junction barrier function using the esophagogastric junction contractile integral: an observational cohort study.Dis Esophagus 29, no. 7 (October 2016): 820–28. https://doi.org/10.1111/dote.12389.
Gor, P., et al. “Interrogation of esophagogastric junction barrier function using the esophagogastric junction contractile integral: an observational cohort study.Dis Esophagus, vol. 29, no. 7, Oct. 2016, pp. 820–28. Pubmed, doi:10.1111/dote.12389.
Gor P, Li Y, Munigala S, Patel A, Bolkhir A, Gyawali CP. Interrogation of esophagogastric junction barrier function using the esophagogastric junction contractile integral: an observational cohort study. Dis Esophagus. 2016 Oct;29(7):820–828.
Journal cover image

Published In

Dis Esophagus

DOI

EISSN

1442-2050

Publication Date

October 2016

Volume

29

Issue

7

Start / End Page

820 / 828

Location

United States

Related Subject Headings

  • Sensitivity and Specificity
  • Predictive Value of Tests
  • Muscle Contraction
  • Middle Aged
  • Manometry
  • Male
  • Humans
  • Gastroenterology & Hepatology
  • Female
  • Esophagogastric Junction