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Findings on Esophageal Manometry Are Not Predictive of Symptomatic Non-Acid Reflux


Hila, Amine MD; Agrawal, Amit MD; Blonski, Wojciech MD; Castell, Donald O. MD

American Journal of Gastroenterology: September 2006 - Volume 101 - Issue - p S45–S46
Abstracts: ESOPHAGUS

Gastroenterology and Hepatology, Medical University of South Carolina, Charleston, SC.

Purpose: 24-hour multichannel intraluminal impedance and pH (MII-pH) esophageal monitoring allows detection of both acid and non-acid gastroesophageal reflux (GER) episodes. This technology is useful in patients who have persistent GER symptoms on PPIs permitting association of symptoms with the presence of acid or non-acid GER. MII and esophageal manometry (MII-EM) allows both functional and manometric evaluation of the esophagus. It is not known if patients with a positive MII-pH study for non-acid reflux (NAR) have different esophageal MII-EM findings than those who do not have NAR.

Aim: To compare MII-EM characteristics between patients with and without abnormal NAR as proven by MII-pH.

Methods: Review of 60 consecutive MII-pH studies on PPI therapy with a positive symptom index (SI) for NAR (65% females; mean age = 49.75 yrs) and 90 consecutive studies on PPI therapy with a negative SI for NAR (73% females; mean age = 52.5 yrs). All studies performed between 9/02 and 10/05. All patients also had an MII-EM study, which was analyzed for manometric diagnosis, transit abnormalities and LES characteristics.

Results: Table 1 shows prevalence of manometric diagnoses in patients with positive SI for NAR (+NAR) and those with negative SI for NAR (−NAR). There was no significant difference between the manometric diagnoses in the 2 groups (p= 0.47). Table 2 shows prevalence of transit defects by MII in patients with +NAR and –NAR. There was no significant difference in transit abnormalities between the 2 groups (p= 0.35). Also, there was no difference in LES resting pressure (+NAR: meaN = 26 mmHg; −NAR: meaN = 28.3 mmHg) or LES length (+NAR: meaN = 4.5 cm; −NAR: meaN = 4.3 cm) between the 2 groups (p= 0.73 and p= 0.2 respectively). Patients with +NAR had a significantly higher total number of NAR episodes compared to those with –NAR (p < 0.0001; meaN = 46.3 vs 23.2). Mann-Whitney test used.

Table 1

Table 1

Table 2

Table 2

Conclusions: Patients with a positive symptom index for NAR have similar esophageal manometric and transit characteristics as those with a negative symptom index for NAR.

© The American College of Gastroenterology 2006. All Rights Reserved.