Tu1182 High Resolution Esophageal Manometry in Italian Healthy Volunteers: A Comparison With North-American and North-European Values

Abstract

G A A b st ra ct s GERD symptoms before seeking medical attention, and so the manometric changes of new onset RE have not been evaluated prospectively in humans. To elucidate those changes, we induced acute RE by discontinuing PPI therapy in patients who had severe RE that was healed by PPIs, and we studied changes in esophageal motility using high resolution esophageal manometry. Methods: Patients with a prior endoscopy showing LA grade C RE were treated with BID PPIs for at least one month before a baseline endoscopy to document healing, after which PPIs were stopped. High resolution esophageal manometry, multichannel intraluminal impedance(MII)/pH monitoring, endoscopy, and GERD-HRQL symptom scoring were performed at baseline (on PPI) and 2 weeks after stopping PPIs. Esophageal mucosal baseline impedance was calculated at study start and 2 weeks after stopping PPIs, by measuring the impedance at the beginning of the MII/pH study, 5 cm above the LES. Results: 14 patients enrolled; 3 were excluded when baseline endoscopy showed LA B RE, 1 was withdrawn for an unrelated adverse event, and 10 completed the study (9 men, 1 woman, mean age 56.5, range 29-69 years). Comparing baseline values to those 2 weeks after stopping PPIs for the 10 patients, the mean esophageal acid exposure (total % time pH<4) increased from 6.0%±11.4% SD to 27.2%±23.0% (p=.005) and mean GERD-HRQL scores increased from 7.7±9.5 to 12.5±9.2 (p=.02). Esophageal mucosal baseline impedance decreased from 2519±340V at week 0 to 1509±194V (p=.009) 2 weeks after stopping PPIs. 8 of the 10 patients developed moderate-to-severe endoscopic RE by 2 weeks (4 LA grade B, 4 LA grade C). In those 8 patients, the mean distal contractile integral (DCI) decreased from 1184.9±932.8 mmHg.s.cm to 798.9±666.6 mmHg.s.cm (p=.025), the mean LES pressure decreased from 15.9±8.2 mmHg to 12.6±9.0 mmHg (p=.16), and the integrated relaxation pressure (IRP) decreased from 4.8±4.7 mmHg to 0.4±5.4 (p=.01) mmHg. Conclusions: Discontinuing PPIs for 2 weeks in patients who had LA C RE healed by PPI therapy is a valid model of acute RE. These patients can develop severe RE associated with a significant increase in esophageal acid exposure and a significant decrease in esophageal impedance values within those 2 weeks. Our finding that acute RE causes a significant decrease in DCI demonstrates that moderate-to-severe GERD is a cause of hypocontractile esophageal motility alterations.