Detection of GERD With Esophageal Manometry With Impedance

Abstract

Introduction: To investigate the value, if any, of reflux patterns seen on esophageal manometry with impedance. Methods: Studies using esophageal manometry with impedance (Given, Inc.) from Temple University Hospital Digestive Disease Center were examined from 2010-2012. Patients with reflux pattern on impedance were identified. The reflux pattern most often seen is a bolus clearance and a V-shaped bolus reflux pattern from the stomach back up into the esophagus. Control data was taken from normal patients without any upper GI symptoms undergoing esophageal manometry with impedance, along with patients without a reflux pattern on impedance. This group was further subdivided into those with a positive pH study for reflux and those with a negative study. Resting lower esophageal sphincter (LES) pressure, residual LES, presence and size of hiatal hernia, number of reflux episodes on impedance, and mean refluxate height were recorded and analyzed with independent samples T-test using SPSS 22. Results: Seventeen patients had esophageal reflux on impedance. Average reflux height was 11 cm with σ± 3.46, average number of reflux episodes was 9 σ± 3.3. Six of these 17 patients also had a positive pH study while 11 did not (Table 1). Twenty-eight patients did not have an esophageal reflux pattern on impedance; 19 had a positive ambulatory pH study and 9 had a negative pH study. The presence and size of hiatus hernia were larger in the reflux group. There were trends for the refluxate group to have lower LES pressures compared to non-refluxate (Table 2).Table 1: Comparison Between +/− pH study with Refluxate on ImpedanceTable 2: Comparison Between Refluxate on Impedance and Without RefluxateConclusion: Reflux can be detected on the esophageal manometry impedance studies. Patients with reflux pattern on esophageal manometry with impedance have lower resting LES pressures and residual LES pressures but this is not statistically significant, this may be due to the small sample size. Hiatal hernia sizes are larger in those with reflux patterns on impedance. This study suggests that reflux pattern on impedance manometry may define a population of GERD patients with different physiologic parameters than those GERD patients without a reflux pattern.