Esophageal manometry findings in patients with refractory symptoms of gastroesophageal reflux disease

Anti-reflux mucosectomy superior to argon plasma coagulation in managing Barrett's esophagus by improving lower esophageal sphincter pressure and cardiac sphincter valve function: a single-center, retrospective study

Background

Barrett's esophagus (BE) is a premalignant condition, caused principally by gastroesophageal reflux disease (GERD). Anti-reflux mucosectomy (ARMS) is an effective endoscopic treatment for GERD-related BE, utilizing scar tissue in the area of the esophagogastric junction, narrowing the gastric cardia. Thus, an anti-reflux barrier is formed, which obstructs the reflux of gastric contents into the esophagus.

Objectives

Therefore, in this study, we investigated whether GERD-related BE improved post-ARMS by analyzing the changes in lower esophageal sphincter (LES) pressure, Hill's classification for GERD, and GERD-related questionnaires.

Design

In this retrospective study, we observed whether ARMS was superior to argon plasma coagulation (APC) in the management of GERD disease-related BE.

Methods

Ninety-five patients were grouped into two cohorts, with 43 and 52 in the ARMS and APC cohorts, respectively. Four GERD-related questionnaires were administered. The anxiety self-rating scale (SAS) and depression self-rating scale (SDS) were used for the psychological evaluation of both cohorts. Endoscopic manifestations of BE were observed, and Hill's classification for GERD was employed. Moreover, high-resolution esophageal manometry was performed to test esophageal motility. The follow-up period was 6 months post-treatment.

Results

Greater statistically significant improvements in the four GERD-related questionnaires and SAS and SDS scores were observed post-ARMS than post-APC. Lesion residue was statistically significantly lower in the post-ARMS cohort. Six months post-treatment, proton pump inhibitor use was statistically significantly higher in the ARMS cohort. Moreover, Hill's classification grades and the LES pressure improved statistically significantly post-ARMS after this time interval. The operation time and hospitalization duration were statistically significantly longer in the ARMS cohort than in the APC cohort. However, incidence rates of adverse events were similar.

Conclusion

ARMS is more effective than APC as an endoscopic focal mucosal resection procedure for GERD-related BE and is an optional treatment for both BE excision and GERD improvement.

Spectrum of esophageal manometry and 24-h pH impedance findings in non-erosive gastroesophageal reflux disease and response to phenotype-based treatment-A prospective observational study

BACKGROUND AND AIMS

Gastroesophageal reflux disease (GERD) is classified into erosive reflux disease (ERD) and non-erosive reflux disease (NERD). NERD includes three phenotypes: true NERD, functional heartburn (FH) and reflux hypersensitivity (RH). The management of these NERD phenotypes differs. We aimed at studying the spectrum of high-resolution manometry (HRM) and 24-hour impedance-pH findings in Indian patients with NERD, classifying the phenotypes and assessing the response to phenotype-based treatment.

METHODS

We prospectively studied the clinical characteristics, endoscopy, HRM, 24-hour impedance-pH findings, symptom association and response to phenotype-specific treatment in patients with NERD.

RESULTS

Of 53 patients with NERD, the following phenotypes were diagnosed namely: 35 (66%) true NERD, 12 (22.7%) RH and six (11.3%) FH. The esophagogastric junction-contractile integral (EGJ-CI) was low in 60.4% and ineffective esophageal motility (IEM) was present in 53% of patients. The respective median values for true NERD, RH and FH groups were as follows: proximal mean nocturnal baseline impedance (P-MNBI) 2250Ω, 2241Ω, 2550Ω, (p = 0.592), distal (D-MNBI) 1431Ω, 2887.5Ω, 2516Ω (p < 0.001), post-reflux swallow-induced peristaltic wave index (PSPWI) 11.1%, 16%, 18.7% (p = 0.127). Receiver operating characteristic (ROC) curve analyses showed that D-MNBI and PSPWI discriminated FH and RH from true NERD, respectively, with a cut-off of 2376.5Ω (area under curve [AUC]:0.919, p < 0.001), 22.6% (AUC:0.671, p = 0.184) and 2318Ω (AUC:0.919, p =  < 0.001), 16.2% (AUC:0.671, p = 0.079). The median P-MNBI was lower in patients with GERD-associated cough than other symptoms 1325 (1250, -). Fifty (94.3%) patients showed significant improvement in symptom severity scores (p < 0.001) following phenotype-specific treatment.

CONCLUSIONS

In NERD patients, EGJ-CI and IEM were low. D-MNBI and PSPWI could effectively discriminate true NERD from FH and RH, whereas P-MNBI could help diagnose GERD-associated cough. The phenotype-specific treatment provides better symptom relief for patients.