Indian J Gastroenterol. 2025 Dec 29. doi: 10.1007/s12664-025-01821-4. Online ahead of print.
ABSTRACT
BACKGROUND: Phenotyping of gastroesophageal reflux disease (GERD) requires endoscopy, high-resolution esophageal manometry (HREM) and 24-hour pH testing.
METHODS: The present study was conducted to determine HREM parameters associated with positive reflux test (acid exposure time > 4% on 24-hour pH test). Further, creation and validation of manometry GERD score (MGS) to predict positive reflux test was done. Consecutive patients > 18 years referred for HREM and 24-hour pH study between May 2019 and December 2024 were included prospectively. Based on the findings in patients enrolled between May 2019 and May 2022, HREM parameters significantly different in patients with and without positive reflux were noted. Based on odds ratio, each parameter was assigned weightage points to formulate MGS. This score was validated prospectively. Data was analyzed for sensitivity, specificity, positive-predictive value (PPV), negative-predictive value (NPV) and area under the receiver-operating characteristic (AUROC) curve. Optimal cut-off was interpreted based on Index of Union test. A p value < 0.05 was considered statistically significant.
RESULTS: Calibration cohort included 144 patients (90 males)-98 (68%) had positive reflux test. Patients with positive reflux test had higher incidence of abnormal multiple rapid swallows (MRS, p 0.006), esophagogastric junction (EGJ) contractile integral (CI) < 39 (p < 0.0001) and type 2/3 EGJ morphology (p < 0.0001). These parameters were allotted weightage points to formulate MGS (total 5 points). In the validation cohort (n = 151, 95 males), 65 (43%) patients had a positive reflux test. A majority of patients with positive reflux test had MGS > 3.5 (83.1%). MGS score had AUROC equal to 0.85. MGS > 3.5 had sensitivity of 83.1% and specificity 80.2% to detect positive reflux test.
CONCLUSION: EGJ morphology type 2/3, EGJ-CI < 39 mmHg and abnormal MRS were significantly more common in patients with positive reflux test. MGS is useful in predicting positive reflux test.
PMID:41460456 | DOI:10.1007/s12664-025-01821-4
