TY - JOUR
T1 - Improving the Diagnostic Yield of High-Resolution Esophageal Manometry for GERD
T2 - The “Straight Leg-Raise” International Study
AU - Siboni, Stefano
AU - Kristo, Ivan
AU - Rogers, Benjamin D.
AU - De Bortoli, Nicola
AU - Hobson, Anthony
AU - Louie, Brian
AU - Lee, Yeong Yeh
AU - Tee, Vincent
AU - Tolone, Salvatore
AU - Marabotto, Elisa
AU - Visaggi, Pierfrancesco
AU - Haworth, Jordan
AU - Ivy, Megan
AU - Greenan, Garrett
AU - Facchini, Chiara
AU - Masuda, Takahiro
AU - Yano, Fumiaki
AU - Perry, Kyle
AU - Balasubramanian, Gokulakrishnan
AU - Theodorou, Dimitrios
AU - Triantafyllou, Tania
AU - Cusmai, Lorenzo
AU - Boveri, Sara
AU - Schoppmann, Sebastian F.
AU - Gyawali, C. Prakash
AU - Bonavina, Luigi
N1 - Publisher Copyright:
© 2023
PY - 2023/7
Y1 - 2023/7
N2 - Background & Aims: The straight leg raise (SLR) maneuver during high-resolution manometry (HRM) can assess esophagogastric junction (EGJ) barrier function by measuring changes in intraesophageal pressure (IEP) when intra-abdominal pressure is increased. We aimed to determine whether increased esophageal pressure during SLR predicts pathologic esophageal acid exposure time (AET). Methods: Adult patients with persistent gastroesophageal reflux disease (GERD) symptoms undergoing HRM and pH-impedance or wireless pH study off proton pump inhibitor were prospectively studied between July 2021 and March 2022. After the HRM Chicago 4.0 protocol, patients were requested to elevate 1 leg at 45º for 5 seconds while supine. The SLR maneuver was considered effective when intra-abdominal pressure increased by 50%. IEPs were recorded 5 cm above the lower esophageal sphincter at baseline and during SLR. GERD was defined as AET greater than 6%. Results: The SLR was effective in 295 patients (81%), 115 (39%) of whom had an AET greater than 6%. Hiatal hernia (EGJ type 2 or 3) was seen in 135 (46%) patients. Compared with patients with an AET less than 6%, peak IEP during SLR was significantly higher in the GERD group (29.7 vs 13.9 mm Hg; P < .001). Using receiver operating characteristic analysis, an increase of 11 mm Hg of peak IEP from baseline during SLR was the optimal cut-off value to predict an AET greater than 6% (area under the receiver operating characteristic curve, 0.84; sensitivity, 79%; and specificity, 85%), regardless of the presence of hiatal hernia. On multivariable analysis, an IEP pressure increase during the SLR maneuver, EGJ contractile integral, EGJ subtype 2, and EGJ subtype 3, were found to be significant predictors of AET greater than 6% Conclusions: The SLR maneuver can predict abnormal an AET, thereby increasing the diagnostic value of HRM when GERD is suspected. ClinicalTrials.gov ID: NCT04813029.
AB - Background & Aims: The straight leg raise (SLR) maneuver during high-resolution manometry (HRM) can assess esophagogastric junction (EGJ) barrier function by measuring changes in intraesophageal pressure (IEP) when intra-abdominal pressure is increased. We aimed to determine whether increased esophageal pressure during SLR predicts pathologic esophageal acid exposure time (AET). Methods: Adult patients with persistent gastroesophageal reflux disease (GERD) symptoms undergoing HRM and pH-impedance or wireless pH study off proton pump inhibitor were prospectively studied between July 2021 and March 2022. After the HRM Chicago 4.0 protocol, patients were requested to elevate 1 leg at 45º for 5 seconds while supine. The SLR maneuver was considered effective when intra-abdominal pressure increased by 50%. IEPs were recorded 5 cm above the lower esophageal sphincter at baseline and during SLR. GERD was defined as AET greater than 6%. Results: The SLR was effective in 295 patients (81%), 115 (39%) of whom had an AET greater than 6%. Hiatal hernia (EGJ type 2 or 3) was seen in 135 (46%) patients. Compared with patients with an AET less than 6%, peak IEP during SLR was significantly higher in the GERD group (29.7 vs 13.9 mm Hg; P < .001). Using receiver operating characteristic analysis, an increase of 11 mm Hg of peak IEP from baseline during SLR was the optimal cut-off value to predict an AET greater than 6% (area under the receiver operating characteristic curve, 0.84; sensitivity, 79%; and specificity, 85%), regardless of the presence of hiatal hernia. On multivariable analysis, an IEP pressure increase during the SLR maneuver, EGJ contractile integral, EGJ subtype 2, and EGJ subtype 3, were found to be significant predictors of AET greater than 6% Conclusions: The SLR maneuver can predict abnormal an AET, thereby increasing the diagnostic value of HRM when GERD is suspected. ClinicalTrials.gov ID: NCT04813029.
KW - Esophagogastric Junction
KW - Gastroesophageal Reflux Disease (GERD)
KW - High-Resolution Manometry
KW - Intra-abdominal Pressure
KW - Intraesophageal Pressure
KW - Straight Leg Raise Maneuver
UR - http://www.scopus.com/inward/record.url?scp=85149903174&partnerID=8YFLogxK
U2 - 10.1016/j.cgh.2022.10.008
DO - 10.1016/j.cgh.2022.10.008
M3 - Article
C2 - 36270615
AN - SCOPUS:85149903174
SN - 1542-3565
VL - 21
SP - 1761-1770.e1
JO - Clinical Gastroenterology and Hepatology
JF - Clinical Gastroenterology and Hepatology
IS - 7
ER -