Rogers B. etal. Abnormal post reflux swallow induced peristaltic wave (PSPW) index on pH-impedance monitoring associates with hypomotile esophageal motor patterns on esophageal high resolution manometry (HRM). OP233. UEG Jour,2019,V.7(8S)iv.Abstract issue

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Авторы: Rogers B. / Rengarajan A. / Cicala M. / Ghisa M. / Quader F. / Penagini R. / de Bortoli N. / Mauro A. / Ribolsi M. / Savarino E.V. / Gyawali C.P.


Abnormal post reflux swallow induced peristaltic wave (PSPW) index on pH-impedance monitoring associates with hypomotile esophageal motor patterns on esophageal high resolution manometry (HRM)

Rogers B.1, Rengarajan A.2, Cicala M.3, Ghisa M.4, Quader F.5, Penagini R.S.6,
De Bortoli N.7, Mauro A.8, Ribolsi M.9, Savarino E.V.10, Gyawali C.P.5



Перевод на русский язык: Аномальные значения индекса PSPW, полученные при pH-импедансометрии, связаны с паттернами гипокинезии пищевода при манометрии высокого разрешением (HRM)


1 Washington University School of Medicine, St. Louis, United States,
2 Washington University, Internal Medicine, Saint Louis, United States,
3 Università Campus Bio Medico, Gastroenterologia, Rome, Italy,
4 Azienda Ospedaliera di Padova, DISCOG - UOC Gastroenterologia, Vedelago, Italy,
5 Washington University School of Medicine, Division of Gastroenterology, St Louis, United States,
6 Università degli Studi di Milano, Dipto. di Gastroenterologia/Dipto. di Scienze Mediche, Milan, Italy,
7 University of Pisa, Dept. of Gastroenterology, Pisa, Italy,
8 University of Milan, Gastroenterology and Endoscopy Unit, Milano, Italy,
9 University of Rome Tor Vergata, Rome, Italy,
10 University of Padua, Department of Surgery, Oncology and Gastroenterology, Padua, Italy


Contact E-Mail Address: bdrogers (a) wustl.edu

Introduction: Post-reflux Swallow-induced Peristaltic Wave (PSPW) participates in reflux clearance through primary peristalsis, and abnormal PSPW index is a marker for higher reflux burden on pH impedance monitoring. Impaired primary esophageal body peristalsis on HRM also associates with abnormal reflux burden; peristalsis can augment following multiple rapid swallows (MRS), termed contraction reserve. The relationship between PSPW and esophageal body contraction metrics on HRM in the context of reflux disease remains unknown.

Aims & Methods: Our aim was to determine whether a relationship existed between PSPW and esophageal body contraction patterns on HRM in patients being evaluated for reflux disease. Clinical presentation, HRM, and ambulatory pH-impedance studies performed on patients with persisting reflux symptoms were reviewed from five centers (4 in Europe and 1 in US) for this preliminary report. Incomplete studies, achalasia, esophageal outflow obstruction, and prior foregut surgery were exclusions. HRM studies were analyzed according to CC 3.0, and proportions of intact (distal contractile integral, DCI>450 mmHg.cm.s), fragmented (intact with ≥5 cm breaks), ineffective (DCI< 450 mmHg.cm.s), and failed (DCI< 100 mmHg. cm.s) were recorded. The ratio of MRS esophageal body contraction vigor (using distal contractile integral, DCI) to mean contraction vigor from single swallows >1 defined presence of contraction reserve. Total, upright and supine acid exposure time (AET) were extracted from pH-impedance studies (abnormal when total AET>6%, upright AET>6% and supine AET>2%). PSPW was defined as an antegrade swallow within 30 s of completion of an impedance detected reflux episode, and PSPW index was calculated as the proportion of reflux episodes with PSPW on the 24 hour pH impedance study. Univariate comparisons, ANOVA, and linear regression were utilized to investigate potential correlations between PSPW index and contraction patterns.

Results: Of 269 patients (53.1 ± 0.9 yr, 62% F), abnormal AET proportions were found in 77 (28.6%), 111 (41.2%), and 108 (40.1%) for total, upright and supine AET, respectively. Median PSPW index was 0.50, range 0.04-0.89. PSPW index declined progressively with increasing proportions of hypomotile patterns (p< 0.001 for each comparison by ANOVA, Table); there was corresponding increase in AET (p< 0.001 for each comparison by ANOVA). MRS data was available for 140 patients, of which 76.4% had contraction reserve. There was no direct correlation between PSPW index and presence or absence of contraction reserve. However, within ineffective esophageal motility, PSPW was more robust when post MRS DCI was ≥1000 mmHg.cm.s compared to < 1000 mmHg (0.50±0.02 vs. 0.43 ±0.3, respectively, p=0.049) When controlling for physiologic acid burden, regression analysis demonstrated positive correlation between AET and PSPW index (p≤0.02 for each comparison).

    100%
intact
<50%
ineffective 
  50-70%
ineffective
  ≥80%
ineffective
Absent
contractility 
  PSPW index*   0.60±0.02   0.54±0.02   0.52±0.14   0.46±0.03   0.42±0.44
  Total AET* (%)   4.5±0.90   5.0±0.5   6.4±1.7   6.9±1.1   12.3±3.7
  Upright AET* (%)   4.5±0.6   5.6±0.1   6.5±1.8   7.7±1.0   11.6±3.6
  Supine AET* (%)   3.8±1.3   4.3±0.8   5.7±1.9   6.1±1.7   13.2±6.0
*p < 0.001 across groups by ANOVA

[Comparison of PSPW index and acid burden across esophageal body motor patterns]

Conclusion: PSPW index correlates with esophageal body motor pattern, and both associate with abnormal reflux burden. Abnormal PSPW index demonstrates a corresponding gradient of hypomotility on HRM, suggesting that both PSPW and HRM complement evaluation of neuromuscular integrity of esophageal motor function.

Disclosure: Nothing to disclose


27-я Объединенная Европейская Гастроэнтерологическая неделя UEG Week 2019Данная публикация — тезисы доклада (abstract) на 27-й Объединённой Европейской Гастроэнтерологической Неделе UEG Week 2019, г. Барселона.

Тезисы (abstracts) всех докладов UEG Week 2019 (pdf, 12,4 Mb): https://www.ueg.eu/publications/abstractbook



См. также: Параскевова А.В. Объединённая Европейская Гастроэнтерологическая Неделя 2019 (United European Gastroenterological Week 2019) // www.gastroscan.ru, 2019.

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