Skip to main content
SpringerLink
Log in

Basal lower esophageal sphincter pressure in gastroesophageal reflux disease: An ignored metric in high-resolution esophageal manometry

  • Short Report
  • Published:
Indian Journal of Gastroenterology Aims and scope Submit manuscript

Abstract

Manometry and 24-h pH interpretation have seldom been studied. Our aim was to study these parameters as gold standard in reflux disease and to identify predictors of pathological acid reflux. Retrospective case record review of all patients with reflux disease evaluated using endoscopy, manometry, and 24-h pH testing from 2010 to 2016. Patients were categorized using Johnson-DeMeester score into two groups—group I (score > 14.7, normal study) and group II (< 14.7, normal study). These groups were compared for the above-mentioned parameters. Appropriate statistical tests were applied. P-value < 0.05 was considered significant. The study group includes 94 patients (median age 44 years, 63.8% males). Sixty (63.8%) and 34 patients belonged to groups I and II, respectively, 76.6% patients had normal endoscopy while the remaining had mild esophagitis. Peristalsis was normal in 66%, followed by ineffective esophageal motility (19.1%) and fragmented peristalsis (14.9%). Demography, symptoms, endoscopy findings, and peristalsis characteristics were similar between the two groups. Group II patients had significantly lower basal lower esophageal sphincter (LES) pressure (11.9 vs. 16.6; p < 0.02), lower integrated relaxation pressure (5.7 vs. 7.4; p < 0.01), and larger separation between LES and crural diaphragm (1.7 vs. 1.4 cm; p < 0.003). Basal LES pressure < 10 mmHg had the highest likelihood ratio (2.2) to predict an abnormal pH study. Basal LES pressure, integrated relaxation pressure, and hiatus size correlated with pathological acid reflux. Hypotensive basal lower esophageal sphincter pressure was the best predictor of an abnormal pH study but with negative linear correlation.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

References

  1. Vakil N, van Zanten SV, Kahrilas P, et al. The Montreal definition and classification of gastroesophageal reflux disease: a global evidence-based consensus. Am J Gastroenterol. 2006;101:1900–20; quiz 1943.

    Article  Google Scholar 

  2. Sharma PK, Ahuja V, Madan K, Gupta S, Raizada A, Sharma MP. Prevalence, severity, and risk factors of symptomatic gastroesophageal reflux disease among employees of a large hospital in northern India. Indian J Gastroenterol. 2011;30:128–34.

    Article  Google Scholar 

  3. Bhalaghuru CM, Vijaya S, Jayanthi V. Symptomatic gastroesophageal reflux amongst hospital personnel in South India. Indian J Med Sci. 2011;65:355–9.

    Article  CAS  Google Scholar 

  4. Bhatia SJ, Reddy DN, Ghoshal UC, et al. Epidemiology and symptom profile of gastroesophageal reflux in the Indian population: report of the Indian Society of Gastroenterology Task Force. Indian J Gastroenterol. 2011;30:118–27.

    Article  Google Scholar 

  5. Lundell LR, Dent J, Bennett JR, et al. Endoscopic assessment of oesophagitis: clinical and functional correlates and further validation of the Los Angeles Classification. Gut. 1999;45:172–80.

    Article  CAS  Google Scholar 

  6. Sloan S, Rademaker AW, Kahrilas PJ. Determinants of gastroesophageal junction incompetence: hiatal hernia, lower esophageal sphincter, or both? Ann Intern Med. 1992;117:977–82.

    Article  CAS  Google Scholar 

  7. Martinucci I, Bortoli ND, Giacchino M, et al. Esophageal motility abnormalities in gastroesophageal reflux disease. World J Gastrointest Pharmacol Ther. 2014;5:86–96.

    Article  Google Scholar 

  8. International High Resolution Manometry Working Group. The Chicago Classification of esophageal motility disorders, v3.0. Neurogastroenterol Motil. 2015;27:160–74.

    Article  Google Scholar 

  9. Kahrilas PJ, Pandolno JE. Ineffective esophageal motility does not equate to GERD. Am J Gastroenterol. 2003;98:715–7.

    Article  Google Scholar 

  10. Jain M, Baijal R. Characteristics of lower esophageal sphincter function and esophageal motility noted on high resolution esophageal manometry in patients with reflux disease. Glob J Res Anal. 2017;6:287–8.

    Google Scholar 

  11. Li Y, Xie C, Wu KM, Chen MH, Xiao YL. Motility characteristics in the transition zone in gastroesophageal reflux disease (GORD) patients. BMC Gastroenterol. 2016;16:106.

    Article  CAS  Google Scholar 

  12. Ribolsi M, Balestrieri P, Emerenziani S, Guarino MP, Cicala M. Weak peristalsis with large breaks is associated with higher acid exposure and delayed reflux clearance in the supine position in GERD patients. Am J Gastroenterol. 2014;109:46–51.

    Article  CAS  Google Scholar 

  13. Frazzoni M, De Micheli E, Savarino V. Different patterns of oesophageal acid exposure distinguish complicated reflux disease from either erosive refluxoesophagitis or non-erosive reflux disease. Aliment Pharmacol Ther. 2003;18:1091–8.

    Article  CAS  Google Scholar 

  14. Lemme EM, Abrahao-Junior LJ, Manhaes Y, Shechter R, Carvalho BB, Alvariz A. Ineffective esophageal motility in gastroesophageal erosive reflux disease and in nonerosivereflux disease: are they different? J Clin Gastroenterol. 2005;39:224–7.

    Article  Google Scholar 

  15. Martinek J, Benes M, Hucl T, Drastich P, Stirand P, Spicak J. Non-erosive and erosive gastroesophageal reflux diseases: no difference with regard to reflux pattern and motility abnormalities. Scand J Gastroenterol. 2008;43:774–80.

    Article  Google Scholar 

  16. Somani SK, Ghoshal UC, Saraswat VA, et al. Correlation of esophageal pH and motor abnormalities with endoscopic severity of reflux esophagitis. Dis Esophagus. 2004;17:58–62.

    Article  CAS  Google Scholar 

  17. Zaninotto G, DeMeester TR, Schwizer W, Johansson KE, Cheng SC. The lower esophageal sphincter in health and disease. Am J Surg. 1988;155:104–11.

    Article  CAS  Google Scholar 

  18. Tsuboi K, Hoshino M, Sundaram A, Yano F, Mittal SK. Role of the lower esophageal sphincter on esophageal acid exposure – a review of over 2000 patients. Trop Gastroenterol. 2012;33:107–11.

    Article  Google Scholar 

  19. Festi D, Scaioli E, Baldi F, et al. Body weight, lifestyle, dietary habits and gastroesophageal reflux disease. World J Gastroenterol. 2009;15:1690–701.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Gastroenterology, Gleneagles Global Health City, 439, Medavakkam Road, Perumbakkam, Cheran Nagar, Chennai, 600 100, India

    Mayank Jain, M. Srinivas, Piyush Bawane & Jayanthi Venkataraman

Authors
  1. Mayank Jain
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. M. Srinivas
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Piyush Bawane
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jayanthi Venkataraman
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Mayank Jain.

Ethics declarations

Conflict of interest

MJ, MS, PB, and JV declare that they have no conflict of interest.

Ethical clearance

The authors declare that the study was performed in a manner conforming to the Helsinki Declaration of 1975, as revised in 2000 and 2008 concerning human and animal rights, and the authors followed the policy concerning informed consent as shown on Springer.com.

Disclaimer

The authors are solely responsible for the data and the content of the paper. In no way, the honorary editor-in-chief, editorial board members, or the printer/publishers are responsible for the results/findings and content of this article.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Jain, M., Srinivas, M., Bawane, P. et al. Basal lower esophageal sphincter pressure in gastroesophageal reflux disease: An ignored metric in high-resolution esophageal manometry. Indian J Gastroenterol 37, 446–451 (2018). https://doi.org/10.1007/s12664-018-0898-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12664-018-0898-x

Keywords

Search

Navigation