Doctor Medical College of Georgia Augusta, Georgia
Supannee Rassameehiran, MD1, Eula P. Tetangco, MD, MPH2, Amol Sharma, MD, MS, FACG3, Satish S. Rao, MD, PhD, FACG2, Jai Eun Lee, MD2; 1Medical College of Georgia, Augusta, GA; 2Medical College of Georgia at Augusta University, Augusta, GA; 3Augusta University, Augusta, GA
Introduction: Gastroesophageal reflux disease (GERD) is common and up to 1/3 of patients may have symptoms that are refractory to PPI therapy. High-resolution esophageal manometry has been used to identify abnormal peristalsis and major motor disorders in this population together with ambulatory pH monitoring. Our aim was to evaluate the demographic features and pathophysiological mechanisms in patients with PPI-refractory GERD. Methods:
Methods: We conducted a retrospective study of patients with suspected diagnosis of PPI-refractory GERD (symptoms despite PPI for 6 months) starting January 2015. Patients were only included if they underwent high-resolution esophageal manometry and a 48-hr wireless pH monitoring (Bravo®, Medtronics, Minneapolis, MN) Symptom severity was measured using a Likert scare at time of esophageal manometry. Demographics, symptom patterns and physiological data were compared between those with normal and abnormal pH study using SPSS™. Results:
Results: 122 patients met inclusion criteria (Table 1). No statistically significant in demographics and baseline clinical characteristics between 2 groups (normal and abnormal reflux profile). Total of 57 patients (46.7%) had abnormal high-resolution esophageal manometry findings, and this included 3.2% with achalasia, 15.5% with EGJ outflow obstruction and 21.3% with ineffective esophageal motility. However, these features did not show significant association with abnormal reflux profile. Among the continuous variables, severity of heartburn, severity of vomiting, severity of chest pain, resting LES, IRP and contraction duration were all significantly associated with abnormal reflux profile (Table 2). Discussion:
Conclusions: Our study demonstrates that low values for resting LES tone, IRP and contraction duration may each contribute to excess/abnormal acid reflux in patients with PPI refractory GERD. Abnormal manometry findings are common and include ineffective esophageal motility and EGJ outflow obstruction in 46.7% of patients, together with 56.5% having a hiatal hernia. Thus, several symptoms and esophageal manometric abnormalities seem to contribute to the pathogenesis of PPI-refractory GERD, and wherever possible correcting these factors may lead to symptom improvement.
Disclosures: Supannee Rassameehiran indicated no relevant financial relationships. Eula Tetangco indicated no relevant financial relationships. Amol Sharma indicated no relevant financial relationships. Satish Rao indicated no relevant financial relationships. Jai Eun Lee indicated no relevant financial relationships.