Marc Hersh, MD1, Marie L. Godiers, BS2, Anand Jain, MD1; 1Emory University, Atlanta, GA; 2Emory Health Care, Atlanta, GA
Introduction: Hypercontractile and spastic motility changes are hypothesized to be an esophageal response to gastroesophageal reflux disease (GERD). The functional lumen imaging probe (FLIP) measures distension induced esophageal contractility. We aim to compare symptoms, acid exposure, and reflux events as related to esophageal motility pattern on FLIP in patients with presumed GERD. Methods: We prospectively collected data on all patients who underwent FLIP and BravoTM placement during upper endoscopy for evaluation of proton-pump inhibitor (PPI) refractory symptoms presumed to be related to GERD between January 2019 and March 2020. A total of 23 patients were included. Patients with a history of anti-reflux surgery, primary symptoms of dysphagia or a diagnosis of achalasia were excluded. Patients were characterized based on FLIP motility criteria as having either 1) Normal or diminished contractility or 2) Spastic contractility (if FLIP showed esophagogastric junction outflow obstruction or repetitive retrograde contractions). Total and maximal single-day acid exposure % and number of reflux events were compared. Presence of heartburn as the reported primary symptom and GERD questionnaire (GERDQ) scores were also compared. Mann-Whitney test was used to compare continuous variables; Fisher’s exact test was used to compare categorical variables. Results: Normal / diminished and spastic contractility were noted in 14 (61%) and 9 (39%) respectively. Maximal single-day acid exposure % time (4.5% vs 9.2%, p value: 0.02), average acid exposure % time (2.7% vs 6.8%, p value: 0.02) and number of reflux events (24 vs 47.5 events, p value: 0.04) were lower in the spastic contractility group (Figure 1). GERDQ score was 7.5 in the spastic motility group vs 10 in the normal / diminished motility group (p value: 0.8). Seven out of 14 (50%) of the normal / diminished motility group had heartburn in comparison to only 1 out of 9 (11%) in the spastic motility group (p value: 0.08) (Table 1). The most common symptoms in the spastic motility group were non-cardiac chest pain and laryngeal symptoms. Discussion: Spastic motility findings are detected on FLIP in a high proportion of patients with PPI-refractory esophageal symptoms in the absence of dysphagia. Spastic motility on FLIP is associated with less measured acid exposure and a different symptom profile with less heartburn. Studies evaluating resolution of spastic changes and symptoms over time with PPI therapy could confirm this group as a GERD-spectrum entity.
Table 1. Patient characteristics.
Figure 1. BravoTM metrics and Gastroesophageal reflux disease questionnaire (GERDQ) score results in the normal / diminished motility and spastic motility groups are shown. Maximal single-day acid exposure % time and number of reflux events are shown. Group median values are displayed as black bars.
Disclosures: Marc Hersh indicated no relevant financial relationships. Marie Godiers indicated no relevant financial relationships. Anand Jain indicated no relevant financial relationships.