P33 UPPER ESOPHAGEAL SPHINCTER (UES) ABNORMALITIES ARE SIGNIFICANT DIAGNOSTIC FINDINGS IN PATIENTS WITH ATYPICAL GERD UNDERWENT PH-IMPEDANCE AND HIGH RESOLUTION MANOMETRY (HRM)

Abstract

Abstract Aim To investigate UES function in patients underwent esophageal testing with pH-impedance and HRM for suspected GERD Background & Methods GERD is a complex condition with a typical: heartburn, regurgitation or epigastric pain and an atypical presentation with symptoms such as chronic cough, hoarseness, globus, dysphagia or throat clearing caused by the retrograde movement of gastric contents above the UES into the laryngopharynx. The association between GERD and abnormalities of UES and esophageal motility is not clearly known. HRM has allowed accurate measurement and evaluation of UES and esophageal function. We evaluate the UES function of the HRM exams in patients underwent pH-impedance for suspected GERD with typical or atypical symptoms. Results HRM tracings of 60 patients (35F, median age 53,08 R23-74), 35 with typical (20F, m.a 51,42 R24-74) and 25 with atypical (15F, m.a 51,73 R29-74) symptoms who underwent Ph-impedance for suspected typical and atypical GERD were evaluated. 40% of those with typical presentation had a positive pH-impedance for GERD versus 8% of those with atypical symptoms. Patients with typical symptoms presented in 42,85% UES abnormalities versus 60% of the patients with atypical presentation. From those patients with typical GERD symptoms that had a positive pH-impedance the 40% had a concomitant UES abnormality versus 100% of the patients with atypical presentation and a confirmed GERD diagnosis. Statistical analysis revealed a significant association between positive pH-impedance result and LES residual pressure in patients with typical (p=0,045) and atypical (p=0,038) symptoms. Conclusion UES abnormalities is the prevalent diagnostic finding in patients with atypical GERD underwent pH-impedance. UES dysfunction characterize all patients diagnosticated with atypical GERD by Ph-impedance.