Tu1104 Objective Identification of Common Daily Activities by Their Manometric Signatures Using Ambulatory Pressure Recording

Abstract

Background: During pathological assessment of esophageal biopsies several histological features characterizing the diagnosis of microscopic esophagitis [basal cell hyperplasia (BCH), papillary enlongation (PE), dilated intercellular spaces (DIS) and epithelial neutrofilic/eosinophilic infiltration (Neu/Eos)] can be assessed. Limited data are available about the single contribution of these histological abnormalities on the diagnosis of GERD and its related mucosal integrity in well-defined patients with reflux disease. Aim: To determine whether these histological features contribute differently to the diagnosis GERD and to the impairment of mucosal integrity as expressed by baseline impedance (BI) levels. Methods:One hundred and four consecutive patients with typical reflux symptoms underwent upper endoscopy and multiple biopsies were taken at Z-line and 2 cm above it, in order to assess the presence and severity of BCH, PE, DIS and Neu/Eos [0 (absent), 1 (mild), and 2 (marked)]. Within 3 days from endoscopy, patients underwent impedance-pH testing off-therapy. During manual analysis of the impedance-pH tracings, we measured the esophageal acid expsosure time (AET) over the 24 hours and the total (acid + non-acid) number of impedance-detected reflux episodes. We evaluated BI values at 3 and 5cm above the LES, during the overnight rest, for at least 30 minutes after excluding swallows and reflux induced changes. Twenty healthy volunteers (HVs; 11F/9M; mean age 44) who underwent the same procedures were also enrolled as controls. Results:We included 85 patients with an endoscopic/impedancepH diagnosis of GERD (45F/40M; mean age 46) who had esophageal mucosal breaks at upper endoscopy or an abnormal esophageal acid exposure or a normal esophageal acid exposure but a positive reflux-symptom association at impedance-pH testing. Among these patients, BI values at both 3 and 5 cm above the LES positively correlated with the esophageal AET (r2=0.2033, P<0.001 and r2=0.1859, P<0.001, respectively) and the number of impedance-detected reflux episodes (r2=0.1373, P<0.001 and r2=0,1526, P<0.001, respectively). Moreover, as shown in the Table, BCH and DIS were the lesions more significantly correlated with the endoscopic/impedance-pH diagnosis of GERD. No significant correlation was observed between BI values and impedance-pH parameters or histological lesions in HVs (p=ns). Conclusions: BCH and DIS contribute more than PE and Eos/Neu to the endoscopic/ impedance-pH diagnosis of GERD. Moreover, the same lesions seem to play a greater role than PE and Eos/Neu in determining mucosal integrity impairment as expressed by BI values in GERD patients. Overall, BCH and DIS can be considered the histological markers requiring more carefully evaluation during pathologic assessment in order to help the diagnosis of GERD. Correlation of BI levels with ME histologic features