P0328 - Functional Heartburn and Esophageal Hypersensitivity Frequency in Patients With Refractory Gastroesophageal Reflux Symptoms: Using the Roma IV Consensus and a Series of Diagnostic Procedures in Lima, Peru

Sunday, October 24, 2021

3:30 PM – 7:00 PM PT

Location: Shoreline Exhibit Hall

Has Audio

Presenting Author(s)

Jorge Luis Espinoza-Ríos, MD

Universidad Peruana Cayetano Heredia
Lima, Lima, Peru

Luis A. Piza, MD¹, Mercedes Cárdenas-Oña, MD¹, Ximena Vásquez-Ojeda, MD¹, Edith Rosas-Marcos, MD², Carmen Alurralde-Miranda, MD³, Frine Samalvides-Cuba, MD¹, Jorge Espinoza-Ríos, MD¹
¹Universidad Peruana Cayetano Heredia, Lima, Lima, Peru; ²Clínica Golf SANNA, Lima, Lima, Peru; ³Clínica Internacional, Lima, Lima, Peru

Introduction: Gastroesophageal reflux disease (GERD) is a clinical condition in which gastric reflux causes bothersome symptoms or damage to the esophageal mucosa. Up to 45% of patients with suspected GERD are refractory to treatment. A digestive endoscopy does not show lesions in approximately 70% of patients. In this scenario, it is necessary to perform an esophageal pH-impedance measurement, a procedure that allows to determine whether exposure to gastric acid is pathological. Of this group, patients with pathological acid exposure are diagnosed as true non-erosive reflux disease (NERD). If patients have a physiological exposure to gastric acid, they suffer from esophageal hypersensitivity or functional heartburn, which are functional disorders, according to the Rome IV consensus. These require a different treatment approach from that of GERD or NERD, as they differ at a physiological level.

Methods: Retrospective cross-sectional study. Data was collected by reviewing pH-impedance and manometry reports, selecting 166 patients with at least 8 weeks of anti-secretory treatment. Based on previous reported prevalence and the available sample size, potency of the study resulted in 99.93%. Esophageal pH-impedance and manometry were performed by three trained gastroenterologists. Equipment and result reports were standardized. Analysis

Results: The frequency of functional disorders was 86.15%, 78 (46.9%) of patients had functional heartburn, 65 (39.2%) had esophageal hypersensitivity and 23 (13.8%) had true NERD. Mean age difference between functional disorders and true NERD groups was statistically significant (p < 0.03). Abnormal esophageal motility was associated with presenting true NERD (OR: 2.64; 95% CI [1.07-6.52]).

Discussion: The aims of the study were to calculate the frequency of esophageal hypersensitivity and functional heartburn in patients with refractory reflux symptoms, and to establish clinical predictors based on sociodemographic and clinical characteristics and results from diagnostic procedures. The frequency of functional disorders was found to be higher than that reported in previous studies, probably dietary, cultural, ethnic or lifestyle factors inherent to our environment play important roles in these results. Age was a determinant factor to predict true NERD, being more common in older patients. This reflects on the possible aging effects over the esophageal motility or tonicity that grant more frequent exposure to reflux episodes.

Adjusted OR [ 95% CI]
	FH (n=78)	P value	EH (n=65)	P value	True NERD (n=23)	P value
Gender
Female	1.34 [0.73-2.46]	0.44	0.70 [0.37-1.31]	0.34	1.11 [0.46-2.67]	1.00
Male	0.75 [0.41-1.38]	0.44	1.41 [0.76-2.67]	0.34	0.90 [0.37-2.18]	1.00
Age
≥ age mean*	1.29 [0.71-2.37]	0.44	0.51 [0.27- 0.97]	< 0.05	2.91 [1.17-7.15]	< 0.02
Symptoms
Typical**	0.66 [0.33-1.33]	0.28	1.41 [0.67-2.91]	0.47	1.26 [0.44-3.62]	0.80
Atypical	5.43 [1.16-25.31]	< 0.02	1.49 [0.44-5.06]	0.57	0.10 [0.03-0.33]	< 0.01
% AET
< 4%	11.07 [3.20-38.23]	< 0.01	3.95 [1.43-10.93]	< 0.01	-	-
4-6%	0.67 [0.10-1.56]	0.22	1.32 [0.39-4.51]	0.75	2.53 [0.62-10.34]	0.18
Total reflux episodes
> 80	0.033 [0.00-0.25]	< 0.01	0.52 [0.21-1.32]	0.19	60.75 [17.92-205.9]	< 0.01
80-40	0.36 [0.19-0.7]	< 0.01	5.43 [2.74-10.74]	< 0.01	0.21 [0.06 -0.73]	< 0.01
< 40	9.23 [4.55-18.70]	< 0.01	0.27 [0.14-0.53]	< 0.01	0.09 [0.02- 0.38]	< 0.01
DeMeester Score
≥ 14.7	0.03 [0.00-0.2]	< 0.01	0.33 [0.13-0.85]	< 0.02	-	0.00
< 14.7	37.85 [5.01-285.91]	< 0.01	3.06 [1.18-7.98]	< 0.02	-	0.00
GEJ morphology
I	2.77 [1.37-5.62]	< 0.01	0.47 [0.24-0.92]	< 0.04	0.63 [0.25-1.56]	0.33
II	0.49 [0.24-1.03]	0.07	1.69 [0.83-3.45]	0.20	1.40 [0.53-3.69]	0.60
III	0.13 [0.02-1.06]	< 0.04	3.32 [0.80-13.79]	0.16	1.85 [0.36-9.51]	0.36
Esophageal motility
Normal	2.15 [1.14-4.07]	< 0.03	0.75[0.4-1.41]	< 0.42	0.38 [0.15-0.93]	< 0.04
Abnormal	0.47 [0.25-0.88]	< 0.03	1.34 [0.71-2.52]	< 0.42	2.64 [1.07-6.52]	< 0.04
LES Tonicity
Competent	1.67 [0.90-3.1]	0.12	0.82 [0.43-1.53]	0.63	0.50 [0.19-1.28]	0.18
Hypotonic	0.6 [0.32-1.11]	0.12	1.23 [0.65-2.29]	0.63	2.02 [0.78-5.19]	0.18
SGB	0.27 [0.10-0.7]	< 0.01	2.67[1.150-6.21]	< 0.03	1.53 [0.51-4.54]	0.54

Table: Multivariate analysis of predictors of occurrence of non-erosive reflux disease and functional disorders.
OR: odds ratio FH: functional heartburn, EH: esophageal hypersensitivity, true NERD: true non-erosive reflux disease, %AET: acid exposure time, SGB: supragastric belching, GEJ: gastroesophageal junction, LES: lower esophageal sphincter.
*Age mean (years): Functional heartburn = 46.44; esophageal hypersensitivity = 43.11; Non erosive reflux disease = 50.87.
**At least one typical symptom: heartburn or regurgitation.

Disclosures:
Luis Piza indicated no relevant financial relationships.
Mercedes Cárdenas-Oña indicated no relevant financial relationships.
Ximena Vásquez-Ojeda indicated no relevant financial relationships.
Edith Rosas-Marcos indicated no relevant financial relationships.
Carmen Alurralde-Miranda indicated no relevant financial relationships.
Frine Samalvides-Cuba indicated no relevant financial relationships.
Jorge Espinoza-Ríos indicated no relevant financial relationships.

Luis A. Piza, MD¹, Mercedes Cárdenas-Oña, MD¹, Ximena Vásquez-Ojeda, MD¹, Edith Rosas-Marcos, MD², Carmen Alurralde-Miranda, MD³, Frine Samalvides-Cuba, MD¹, Jorge Espinoza-Ríos, MD¹. P0328 - Functional Heartburn and Esophageal Hypersensitivity Frequency in Patients With Refractory Gastroesophageal Reflux Symptoms: Using the Roma IV Consensus and a Series of Diagnostic Procedures in Lima, Peru, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.