Esophageal physiologic profiles within erosive esophagitis in China: Predominantly low-grade esophagitis with low reflux burden.

Abstract

The Lyon Consensus defines LA grades C&D erosive esophagitis (EE) or acid exposure time (AET) >6% as the conclusive evidence for gastro-esophageal reflux disease (GERD). However, most of EE is LA grade A&B and the rate of AET exceeding 6% is low in China. We aimed to evaluate patients with EE in the Chinese population based on the Lyon Criteria. A retrospective study was performed among patients with EE who had esophageal function tests performed in a tertiary hospital from 2013 to 2017. Erosive esophagitis was staged according to the Los Angeles classification. Their motor profiles from high-resolution manometry (HRM), reflux profiles from multichannel intraluminal impedance-pH (MII-pH) monitoring and proton pump inhibitor (PPI) efficacy were analyzed. Patients were categorized as conclusive or inconclusive GERD. Among 112 patients with EE who underwent esophageal function tests, EE of LA grade C&D was found in only 4.46% (N=5). Almost 35% (N=37) of patients with LA grade A&B EE had AET exceeded 6%, who had good PPI response similar to those with LA grade C&D EE (77.42% vs 100%, P=.559). The remaining 70 patients (62.50%) were inconclusive GERD, of whom 56.25% responded to PPI. Inconclusive GERD patients had a wide range (7.14%-97.14%) of positive adjunctive evidences from HRM and MII-pH monitoring without significant correlation to PPI response rate. The reflux burden within patients with EE is predominantly low in China, and adjunctive HRM and MII-pH profiles from Lyon criteria do not segregate PPI response.