Esophagogastric junction contractile integral abnormalities in patients with proton pump inhibitor-refractory symptoms

Objectives Esophagogastric junction contractile integral (EGJ-CI) is a novel indicator to evaluate quantitatively the esophagogastric junction (EGJ) barrier function. We aimed to assess the role of EGJ-CI in patients with refractory gastroesophageal reflux disease (GERD) symptoms and the correlation between EGJ-CI and impedance-pH monitoring characteristics. Methods In total 82 patients with proton pump inhibitors (PPIs)-refractory gastroesophageal reflux symptoms (heartburn or regurgitation) were enrolled. These patients were further divided into two groups based on their EGJ-CI value (39 mmHg center dot cm). The mean nocturnal baseline impedance (MNBI) was measured to explore its association with EGJ-CI. Results The median EGJ-CI in patients with PPI-refractory symptoms was 30.8 mmHg center dot cm. EGJ-CI was inversely correlated with acid exposure time and reflux episodes; while it was positively correlated with MNBI, distal contractile integral, lower esophageal sphincter basal pressure and integrated relaxation pressure. Patients were further divided into the high (n = 27) and low (n = 55) EGJ-CI groups using a cut-off value of 39.0 mmHg center dot cm. Patients with a low EGJ-CI had a lower MNBI level than those with a high EGJ-CI (2703 omega vs 3545 omega, P = 0.034). Conclusions In patients with PPIs-refractory symptoms, EGJ-CI is associated with acid exposure and conventional high-resolution manometry parameters. EGJ-CI may play an important role in the diagnosis and treatment of patients with refractory GERD.

Automated summary

This study aimed to assess the role of EGJ-CI in patients with refractory GERD symptoms and found that EGJ-CI is inversely correlated with acid exposure time and reflux episodes, while positively correlated with MNBI, distal contractile integral, lower esophageal sphincter basal pressure, and integrated relaxation pressure. In addition, patients with a low EGJ-CI had a significantly lower MNBI level compared to those with a high EGJ-CI.