Artemis Trikola, MD, Nir Bar, MD, Brian Surjanhata, MD, Kyle Staller, MD, MPH, Christopher Velez, MD, Braden Kuo, MD Massachusetts General Hospital, Boston, MA
Introduction: Baseline impedance (BI) measured during a multichannel intraluminal impedance -pH (MII-pH) study is able to distinguish patients with gastro-esophageal reflux disease (GERD). Limited data suggest BI measured during high resolution esophageal impedance manometry (HRIM) could be helpful in detecting patients with GERD or Barrett’s esophagus. Nevertheless, measurement of BI with HRIM is not done routinely. We aim to assess whether BI measured during HRIM (HRIM-BI) could serve to detect patients with GERD, thus eliminating the need for further evaluation.
Methods: We retrospectively collected consecutive patients who underwent HRIM and MII-pH study off acid suppression, from May 2021 through May 2022. HRIM-BI measurement was done manually during the landmark period in the beginning of the study, where we measured impedance values at different levels above the LES (0, 5, 10 and 15 cm above LES). Mean nocturnal BI (MNBI) was measured in the MII-pH in the distal sensor (5 cm above the LES) over three 10 minute intervals around 1, 2, and 3 am (Reflux reader 6.1.1 Medronic Inc.). GERD was defined as acid exposure time (AET) >6%, whereas non GERD group included patients without or borderline GERD.
Results: We have included 60 patients (31 females) with a mean age 38 ± 5.5 years. Of the total cohort, 42 patients had AET< 6% and 18 patients (30%) had MNBI under 1500 Ohm. MNBI and HRIM-BI at the 5 cm proximal to the LES were moderately correlated (Spearman Rho=0.439 p< 0.001). This level showed the best correlation to MNBI. A cut-off of MNBI< 1500 ohm had good discriminating properties in detecting GERD with area under the receiver operating characteristics curve AUROC of 0.884 (95% CI0.774-0.995, p< 0.0001). However, HRIM-BI could not discriminate between GERD and non-GERD AUROC of HRIM-BI 5 cm proximal to LES was 0.659 (0.5-0.818, p=0.053). None of the levels had adequate discriminating properties.
Discussion: Our results support previously published reports of the usefulness of MII-ph MNBI in detecting GERD. Unfortunately, our data do not support the use of HRIM BI in detecting GERD and obviating the need of 24 hour MII-pH, contrary to prior reports. The HRIM-pH does not correlate well to MNBI and has inadequate discriminatory properties. In conclusion, landmark impedance measurements of HRIM do not discriminate well between GERD and non-GERD patients.
Disclosures:
Artemis Trikola indicated no relevant financial relationships.
Nir Bar indicated no relevant financial relationships.
Brian Surjanhata indicated no relevant financial relationships.
Kyle Staller: Arena Pharmaceuticals, Gelesis, GI Supply, and Shire (Takeda Pharmaceutical Company Ltd) – Consultant. Ironwood Pharmaceuticals, Inc. and Urovant Sciences, Inc. – Grant/Research Support.
Christopher Velez indicated no relevant financial relationships.
