Tu1779 Factors Associated With Erosive Esophagitis in Patients Undergoing Esophageal Manometry and Combined 24 Hour pH Monitoring and Multichannel Intraluminal Impedance Studies

Abstract

Background: A subset of patients with gastroesphageal reflux disease (GERD) symptoms has erosive esophagitis (E+) on upper endoscopy (EGD). Those whose symptoms persist despite proton pump inhibitor (PPI) therapy may further undergo testing with combined multichannel intraluminal impedance and 24 hour pH (MII-pH) to determine if acid is adequately suppressed and if non-acid reflux plays a role in symptoms. Aim: To determine which factors on esophageal manometry (EM) and MII-pH were associated with E+. A secondary aim is to examine the relationship between the degree of E+ and 24 hour pH score. Methods: A clinical database was searched for EM and MII-pH studies performed off acid suppressive therapy between 2006 and 2011. Patients referred for evaluation had typical GERD symptoms (heartburn or acid regurgitation) or atypical symptoms (chest pain, cough, hoarseness, dysphagia or dyspepsia). Data was further extracted to patients who had an EGD performed within 6 months of the MII-pH study. Patients with a normal esophagus on EGD or eosinophilic esophagitis were excluded from this study. Erosive esophagitis was defined and graded according to the Los Angeles classification system. A Johnson-DeMeester score of ≥22 was considered diagnostic for GERD by pH testing. An abnormal impedance study was defined as .73 distal reflux episodes. Categorical data was expressed as percentages and continuous data as means and standard deviation. Fisher's exact tests and parametric statistics were used to analyze data. A p-value ≤ 0.05 was considered statistically significant. Results: Of 348 patients identified in the database, 21 patients had E+ (67% were males, 76% were Caucasians and 79%hadGrade A esophagitis). Themajority of patients (95%)were previously treated with PPI, however all cases were performed off PPI for at least one week. Significantly more patients with E+ had hiatal hernias compared to patients without esophagitis (E-), (43% vs 19%,p=0.021). E+ patients had significantly more acid reflux episodes than Epatients (46±40 vs 27±26, p=0.011). There was also significantly more distal impedance episodes (73±59 vs 49±27,p=0.014) and decreased lower esophageal sphincter (LES) pressure in E+ patients (12±11 mm Hg vs 15±11 mm Hg, p=0.012). E+ and Epatients had similar degree of upright acid reflux (pH:4.91±4.0 vs pH:4.98±6.3, p=0.224). E+ patients had more supine acid reflux than Epatients without statistical significance (pH:5.8 ±14.8 vs pH:2.4±7.3, p=0.177). Conclusions: Hiatal hernia, decreased LES pressure, and total number of reflux episodes were associated with E+. There was a trend in more supine reflux in E+ patients, however no difference in upright reflux was observed between the two groups. Due to the small number of higher grade E+ cases, a correlation could not be made between severity of degree of E+ and 24 hour pH score.