High-resolution manometry determinants of refractoriness of reflux symptoms to proton pump inhibitor therapy

Mentore Ribolsi, Edoardo Savarino, Benjamin Rogers, Arvind Rengarajan, Marco Della Coletta, Matteo Ghisa, Michele Cicala, C. Prakash Gyawali

Research output: Contribution to journalArticlepeer-review

8 Scopus citations


Background/Aims Impaired esophageal motility and disrupted esophagogastric junction (EGJ) on high-resolution 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 99 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.

Original languageEnglish
Pages (from-to)447-454
Number of pages8
JournalJournal of Neurogastroenterology and Motility
Issue number4
StatePublished - Oct 2020


  • Esophagogastric junction
  • Gastroesophageal reflux
  • Heartburn
  • Manometry
  • Proton pump inhibitors


Dive into the research topics of 'High-resolution manometry determinants of refractoriness of reflux symptoms to proton pump inhibitor therapy'. Together they form a unique fingerprint.

Cite this