Mean Basal Esophagogastric Junction Pressure Is a Better High-resolution Manometry Predictor of Gastroesophageal Reflux Disease Than Esophagogastric Junction Contractile Integral
- Author:
Edoardo VESPA
1
;
Alberto BARCHI
;
Jacopo FANIZZA
;
Rukaia BARÀ
;
Ernesto FASULO
;
Sarah BENCARDINO
;
Francesca BERNARDI
;
Ilaria FAGGIANI
;
Silvio DANESE
;
Sandro PASSARETTI
Author Information
- Publication Type:Original Article
- From:Journal of Neurogastroenterology and Motility 2026;32(1):35-45
- CountryRepublic of Korea
- Language:English
-
Abstract:
Background/Aims:Esophagogastric junction contractile integral (EGJ-CI) is a metric of EGJ barrier function assessed on high-resolution manometry (HRM). However, its clinical utility may be limited by measurement discrepancies and wide variability. Mean basal EGJ pressure (MBEP) is a novel, simple HRM metric assessing barrier function. We compared their performance to predict conclusive gastroesophageal reflux disease (GERD).
Methods:Consecutive patients undergoing esophageal function testing for known or suspected GERD were retrospectively evaluated. MBEP and EGJ-CI were manually calculated. Conclusive GERD was defined as acid exposure time > 6% or histologically confirmed Barrett’s esophagus. Statistical analyses including Mann-Whitney and Kruskal-Wallis tests, receiver operating characteristic (ROC) curves, univariable and multivariable logistic regression were performed.
Results:Two hundred and twenty-six patients (mean age 52.8 ± 14.6 years, 58% males) were included. Applying Lyon 2.0 consensus criteria, 41% had conclusive GERD, 8% had borderline GERD, 8% had reflux hypersensitivity, and 43% had no GERD evidence. Patients with conclusive GERD had significantly lower MBEP compared to those without (11.8 mmHg vs 18.5 mmHg; P < 0.001). MBEP showed greater predictive performance for conclusive GERD (area under the ROC curve [AUROC]: 0.71; 95% CI, 0.65-0.78) than EGJ-CI (AUROC: 0.66; 95% CI, 0.59-0.74), also discriminating Lyon 2.0 subgroups (P < 0.001) and EGJ morphology types (P < 0.001). On multivariable analysis, MBEP independently predicted conclusive GERD (per 1-mmHg increase OR, 1.11; P = 0.022), while EGJ-CI did not (OR, 0.99; P = 0.207).
Conclusions:MBEP is a simple HRM metric to evaluate anti-reflux barrier function, predicting conclusive GERD and differentiating reflux phenotypes with better performance than EGJ-CI. This metric could serve as a valuable adjunctive tool in GERD diagnosis.
