Esophageal chemical clearance and mucosa integrity values in refractory gastroesophageal reflux disease patients with different esophageal dynamics

Abstract

Objectives

Esophageal post-reflux swallow-induced peristaltic wave index (PSPWI) and mean nocturnal baseline impedance (MNBI), novel impedance-based markers of reflux burden, are associated with esophageal dynamics. We aim to investigate the characteristics of PSPWI and MNBI in Chinese refractory gastroesophageal reflux disease (RGERD) patients with different esophageal dynamic changes.

Materials and methods

201 RGERD and 76 functional heartburn patients, undergone off-PPI endoscopy, esophageal manometry and impedance-pH monitoring, were included. Comparisons of conventional and novel impedance-pH metrics were made among different esophageal dynamics groups. Receiver operating-characteristic analyses were utilized to evaluate the diagnostic efficacy of PSPWI and MNBI in differentiating abnormal esophageal dynamics. Correlations were used to investigate their associated factors.

Results

PSPWI and MNBI of RGERD with esophagogastric junction (EGJ) injury and esophageal dysmotility were lower than EGJ injury alone or normal dynamics (p < 0.05 for both comparisons). PSPWI with esophageal peristalsis abnormality was lower than EGJ injury (p = 0.049), while MNBI showed no statistical difference. PSPWI, MNBI and their combination have auxiliary diagnostic values for esophageal peristalsis [area under the curves (AUCs): 0.683, 0.656, 0.708)] while only their combination for EGJ injury (AUC: 0.610). And they positively correlated with esophageal motility while negatively correlated with ineffective swallows and acid reflux events.

Conclusions

PSPWI and MNBI, indicating impairment of esophageal chemical clearance and mucosa integrity, were lower in RGERD patients with multiple esophageal dynamic injuries than single injuries or normal dynamics. Moreover, they provided useful contributing information for potential dynamic injuries if manometry has already been found normal or marginal.

Keywords:

• Refractory gastroesophageal reflux disease
• post-reflux swallow-induced peristaltic wave index
• mean nocturnal baseline impedance
• esophagogastric junction barrier
• esophageal peristalsis

Acknowledgments

The authors are grateful to all members of the Second Gastroenterology Department of The First Affiliated Hospital of Dalian Medical University for their contributions to the manuscript preparation.

Author contributions

Zhijun Duan contributed to the concept and design of the study; Yanqiu Li performed the research, analyzed the data and drafted the manuscript. Lixia Wang, Xiaoling Geng and Xiaoyu Sun contributed to the collection of the data. Dong Yang, Zhifeng Zhang and Jiarong Lin calculated the value of PSPWI. All authors approved the final version of the manuscript.

Disclosure statement

No potential conflict of interest was reported by the author(s).