Simple Manometric Index for Comprehensive Esophagogastric Junction Barrier Competency Against Gastroesophageal Reflux

Abstract

The esophagogastric junction (EGJ) is an anatomic and physiologic barrier against gastroesophageal reflux. Comprehensive evaluation of EGJ barrier parameters using high-resolution manometry in patients with GERD has not been well established. We propose a simple index for comprehensive EGJ antireflux competency. Patients who underwent high-resolution manometry and 24-hour pH monitoring between January 2017 and September 2018 were included. Of these, patients with normal esophageal motility were selected. EGJ antireflux competency was assessed based on the following 3categories: anatomic configuration of the EGJ complex (ie EGJ morphology), backflow-preventive pressure on the lower esophageal sphincter (LES) (ie LES pressure integral), and backflow-promotive pressure across the LES (ie thoracoabdominal pressure gradient). Each category was scored on a scale of 0 to 2, applying clinically meaningful divisions, and a cumulative score was calculated (EGJ index: 0 to 6 points). DeMeester score > 14.72 indicated GERD. In total, 259 patients met study criteria. Of these, GERD was noted in 109 patients (42.1%). The pH parameters were gradually exacerbated, depending on the EGJ index. Good correlations were seen between EGJ index and previously proposed parameters for EGJ disruption, including LES length, LES pressure, and LES pressure integral (area under the curve > 0.9 [excellent validation]). No patient had GERD if the EGJ index score was 0. However, GERD was seen in as high as 85.7% of patients with the highest score of6. EGJ disruption severity was clearly graded based on a simple scoring method, which can improve evaluation and development of clinical strategies for GERD.