Background/aims: Impaired esophageal motility and disrupted esophagogastric junction (EGJ) on highresolution manometry (HRM) have been associated with increased reflux severity in gastroesophageal reflux disease (GERD) patients. However, there are limited data evaluating HRM parameters in proton pump inhibitors (PPI) non-responders.
Methods: Clinical and endoscopic data, HRM and multichannel intraluminal impedance-pH studies performed of PPI therapy in patients with typical GERD symptoms were reviewed from 3 international centers. Frequency of GERD symptoms was assessed on and off PPI therapy in both non-responders (< 50% symptom improvement on PPI therapy) and responders. Rome IV definitions identified non-erosive reflux disease, reflux hypersensitivity, and functional heartburn. Univariate and multivariate analyses were performed to determine predictors of non-response.
Results: Of 204 patients, 105 were PPI non-responders and 94 were responders. Non-responders showed higher EGJ contractile integral values, and a lower frequency of type II and III EGJ morphology (P ≤ 0.03 for each comparison). Esophageal body diagnoses on HRM (fragmented peristalsis, ineffective esophageal motility, or absent peristalsis) did not predict non-response. On multivariate analysis, non-pathological acid exposure time (OR, 2.5; 95% CI, 1.2-5.0; P < 0.001), normal mean nocturnal baseline impedance values (OR, 2.7-2.4; 95% CI, 1.0-6.1; P < 0.05), normal EGJ contractile integral values (OR, 3; 95% CI, 1.3-7.4; P = 0.012), and presence of type I EGJ morphology (OR, 1.9; 95% CI, 1.0-3.4; P = 0.044) were associated with an unfavorable response to PPIs.
Conclusions: Intact EGJ metrics on HRM complement normal reflux burden in predicting non-response to PPI therapy. HRM has value in the evaluation of PPI non-responders.
Keywords: Esophagogastric junction; Gastroesophageal reflux; Heartburn; Manometry; Proton pump inhibitors.
Quantifying esophagogastric junction contractility with a novel HRM topographic metric, the EGJ-Contractile Integral: normative values and preliminary evaluation in PPI non-responders.Neurogastroenterol Motil. 2014 Mar;26(3):353-60. doi: 10.1111/nmo.12267. Epub 2013 Dec 3. Neurogastroenterol Motil. 2014. PMID: 24460814 Free PMC article.
Predictors of proton pump inhibitor failure in non-erosive reflux disease: A study with impedance-pH monitoring and high-resolution manometry.Neurogastroenterol Motil. 2016 May;28(5):674-9. doi: 10.1111/nmo.12763. Epub 2016 Jan 14. Neurogastroenterol Motil. 2016. PMID: 26768192
Esophagogastric junction and esophageal body contraction metrics on high-resolution manometry predict esophageal acid burden.Neurogastroenterol Motil. 2018 May;30(5):e13267. doi: 10.1111/nmo.13267. Epub 2017 Dec 21. Neurogastroenterol Motil. 2018. PMID: 29266647
The Utility of Esophageal Motility Testing in Gastroesophageal Reflux Disease (GERD).Curr Gastroenterol Rep. 2019 Jul 10;21(8):37. doi: 10.1007/s11894-019-0704-7. Curr Gastroenterol Rep. 2019. PMID: 31289922 Review.
ARE THE PERSISTENT SYMPTOMS TO PROTON PUMP INHIBITOR THERAPY DUE TO REFRACTORY GASTROESOPHAGEAL REFLUX DISEASE OR TO OTHER DISORDERS?Arq Gastroenterol. 2018 Nov;55Suppl 1(Suppl 1):85-91. doi: 10.1590/S0004-2803.201800000-48. Epub 2018 Oct 4. Arq Gastroenterol. 2018. PMID: 30304291 Review.