Esophagogastric junction morphology is associated with a positive impedance‐<scp>pH</scp> monitoring in patients with <scp>GERD</scp>

<jats:title>Abstract</jats:title><jats:sec><jats:title>Background</jats:title><jats:p>High‐resolution manometry (<jats:styled-content style="fixed-case">HRM</jats:styled-content>) provides information on esophagogastric junction (<jats:styled-content style="fixed-case">EGJ</jats:styled-content>) morphology, distinguishing three different subtypes. Data on the correlation between <jats:styled-content style="fixed-case">EGJ</jats:styled-content> subtypes and impedance‐pH detected reflux patterns are lacking. We aimed to correlate the <jats:styled-content style="fixed-case">EGJ</jats:styled-content> subtypes with impedance‐pH findings in patients with reflux symptoms.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>Consecutive patients with suspected gastroesophageal reflux disease (<jats:styled-content style="fixed-case">GERD</jats:styled-content>) were enrolled. All patients underwent <jats:styled-content style="fixed-case">HRM</jats:styled-content> and impedance‐pH testing off‐therapy. <jats:styled-content style="fixed-case">EGJ</jats:styled-content> was classified as: Type I, no separation between the lower esophageal sphincter (<jats:styled-content style="fixed-case">LES</jats:styled-content>) and crural diaphragm (<jats:styled-content style="fixed-case">CD</jats:styled-content>); Type II, minimal separation (>1 and <2 cm); Type III, ≥2 cm separation. We measured esophageal acid exposure time (<jats:styled-content style="fixed-case">AET</jats:styled-content>), number of total reflux episodes and symptom association analysis.</jats:p></jats:sec><jats:sec><jats:title>Key Results</jats:title><jats:p>We enrolled 130 consecutive patients and identified 46.2% Type I <jats:styled-content style="fixed-case">EGJ</jats:styled-content>, 38.5% Type II, and 15.4% Type III patients. Type III subjects had a higher number of reflux episodes (61 <jats:italic>vs</jats:italic> 45, <jats:italic>p</jats:italic> < 0.03, <jats:italic>vs</jats:italic> 25, <jats:italic>p</jats:italic> < 0.001), a greater mean <jats:styled-content style="fixed-case">AET</jats:styled-content> (12.4 <jats:italic>vs</jats:italic> 4.2, <jats:italic>p</jats:italic> < 0.02, <jats:italic>vs</jats:italic> 1.5, <jats:italic>p</jats:italic> < 0.001) and a greater positive symptom association (75% <jats:italic>vs</jats:italic> 72%, <jats:italic>p</jats:italic> = 0.732 <jats:italic>vs</jats:italic> 43.3%, <jats:italic>p</jats:italic> < 0.02) compared with Type II and I patients, respectively. Furthermore, Type II subjects showed statistically significant (overall <jats:italic>p</jats:italic> < 0.01) increased reflux when compared with Type I patients. Type III and II EGJ morphologies had a more frequent probability to show a positive multichannel intraluminal impedance pH monitoring than Type I (95% <jats:italic>vs</jats:italic> 84% <jats:italic>vs</jats:italic> 50%, <jats:italic>p</jats:italic> < 0.001).</jats:p></jats:sec><jats:sec><jats:title>Conclusions & Inferences</jats:title><jats:p>Increasing separation between <jats:styled-content style="fixed-case">LES</jats:styled-content> and <jats:styled-content style="fixed-case">CD</jats:styled-content> can cause a gradual and significant increase in reflux. <jats:styled-content style="fixed-case">EGJ</jats:styled-content> morphology may be useful to estimate an abnormal impedance‐pH testing in <jats:styled-content style="fixed-case">GERD</jats:styled-content> patients.</jats:p></jats:sec>