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.

Background/Aims: Decrease of esophageal mean nocturnal baseline impedance reflects loss of mucosal integrity. It can predict response to anti-reflux therapy. Mean nocturnal baseline impedance after transoral incisionless fundoplication for gastroesophageal reflux disease has never been assessed. The aim of the study is to investigate mean nocturnal baseline impedance and conventional pathophysiological parameters following transoral incisionless fundoplication. Methods: Patients prospectively treated by transoral incisionless fundoplication in a single center were retrospectively reviewed regarding 1-and 2-year 24-hour pH-metry and multichannel intraluminal impedance with calculation of mean nocturnal baseline impedance, gastroesophageal reflux disease-health related quality of life and reflux symptom index scores. Results: Thirty-eight and 17/38 patients with 1- and 2-year 24-hour pH-multichannel intraluminal impedance assessment and meannocturnal baseline impedance’s calculation after transoral incisionless fundoplication, respectively, were identified. Mean nocturnal baseline impedance significantly increased up to 2-year follow-up (P = 0.033), along with significant decrease in % of acid exposure time (P = 0.003), gastroesophageal reflux disease-health related quality of life score (P < 0.001), and reflux symptom index (P = 0.008), compared with baseline. The longest orthostatic reflux decreased too, approaching statistical significance (P = 0.054). These significant changes occurred in patients experiencing ≥ 50% reduction of symptom questionnaires’ scores (“responders”). Conversely, mean nocturnal baseline impedance worsened and no significant changes of 24-hour pH-multichannel intraluminal impedance metrics were observed in “non-responder” patients (symptom questionnaires’ scores decrease < 50%). Conclusion In patients who responded a significant improvement of mean nocturnal baseline impedance and % acid exposure time was observed up to 2-year follow-up, suggesting that transoral incisionless fundoplication achieves an effective esophageal mucosa healing besides symptom improvement.

Background/Aims: Decrease of esophageal mean nocturnal baseline impedance reflects loss of mucosal integrity. It can predict response to anti-reflux therapy. Mean nocturnal baseline impedance after transoral incisionless fundoplication for gastroesophageal reflux disease has never been assessed. The aim of the study is to investigate mean nocturnal baseline impedance and conventional pathophysiological parameters following transoral incisionless fundoplication. Methods: Patients prospectively treated by transoral incisionless fundoplication in a single center were retrospectively reviewed regarding 1-and 2-year 24-hour pH-metry and multichannel intraluminal impedance with calculation of mean nocturnal baseline impedance, gastroesophageal reflux disease-health related quality of life and reflux symptom index scores. Results: Thirty-eight and 17/38 patients with 1- and 2-year 24-hour pH-multichannel intraluminal impedance assessment and meannocturnal baseline impedance’s calculation after transoral incisionless fundoplication, respectively, were identified. Mean nocturnal baseline impedance significantly increased up to 2-year follow-up (P = 0.033), along with significant decrease in % of acid exposure time (P = 0.003), gastroesophageal reflux disease-health related quality of life score (P < 0.001), and reflux symptom index (P = 0.008), compared with baseline. The longest orthostatic reflux decreased too, approaching statistical significance (P = 0.054). These significant changes occurred in patients experiencing ≥ 50% reduction of symptom questionnaires’ scores (“responders”). Conversely, mean nocturnal baseline impedance worsened and no significant changes of 24-hour pH-multichannel intraluminal impedance metrics were observed in “non-responder” patients (symptom questionnaires’ scores decrease < 50%). Conclusion In patients who responded a significant improvement of mean nocturnal baseline impedance and % acid exposure time was observed up to 2-year follow-up, suggesting that transoral incisionless fundoplication achieves an effective esophageal mucosa healing besides symptom improvement.

Background/Aims: Decrease of esophageal mean nocturnal baseline impedance reflects loss of mucosal integrity. It can predict response to anti-reflux therapy. Mean nocturnal baseline impedance after transoral incisionless fundoplication for gastroesophageal reflux disease has never been assessed. The aim of the study is to investigate mean nocturnal baseline impedance and conventional pathophysiological parameters following transoral incisionless fundoplication. Methods: Patients prospectively treated by transoral incisionless fundoplication in a single center were retrospectively reviewed regarding 1-and 2-year 24-hour pH-metry and multichannel intraluminal impedance with calculation of mean nocturnal baseline impedance, gastroesophageal reflux disease-health related quality of life and reflux symptom index scores. Results: Thirty-eight and 17/38 patients with 1- and 2-year 24-hour pH-multichannel intraluminal impedance assessment and meannocturnal baseline impedance’s calculation after transoral incisionless fundoplication, respectively, were identified. Mean nocturnal baseline impedance significantly increased up to 2-year follow-up (P = 0.033), along with significant decrease in % of acid exposure time (P = 0.003), gastroesophageal reflux disease-health related quality of life score (P < 0.001), and reflux symptom index (P = 0.008), compared with baseline. The longest orthostatic reflux decreased too, approaching statistical significance (P = 0.054). These significant changes occurred in patients experiencing ≥ 50% reduction of symptom questionnaires’ scores (“responders”). Conversely, mean nocturnal baseline impedance worsened and no significant changes of 24-hour pH-multichannel intraluminal impedance metrics were observed in “non-responder” patients (symptom questionnaires’ scores decrease < 50%). Conclusion In patients who responded a significant improvement of mean nocturnal baseline impedance and % acid exposure time was observed up to 2-year follow-up, suggesting that transoral incisionless fundoplication achieves an effective esophageal mucosa healing besides symptom improvement.