S Roman1,2, R Holloway3, J Keller4, F Herbella5, F Zerbib6, Y Xiao7, L Bernard8, A J Bredenoord9, S Bruley des Varannes10, M Chen3, M Fox11, P J Kahrilas12, R K Mittal13, R Penagini14,15, E Savarino16, D Sifrim17, J Wu18, E Decullier8, J E Pandolfino12, F Mion1,2. 1. Digestive Physiology, Hospices Civils de Lyon, and Lyon I University, Lyon, France. 2. Inserm U1032, LabTAU, Lyon, France. 3. Gastroenterology and Hepatology, Royal Adelaid Hospital, Adelaide, SA, Australia. 4. Department of Internal Medicine, Israelitic Hospital, University of Hamburg, Hamburg, Germany. 5. Department of Surgery, Escola Paulista de Medicina, Federal University of Sao Paulo, Sao Paulo, Brazil. 6. Gastroenterology, CHU Bordeaux and Bordeaux II University, Bordeaux, France. 7. Department of Gastroenterology and Hepatology, The First affiliated Hospital, Sen Yat-sen University, Guangzhou, China. 8. Hospices Civils de Lyon, Pôle Information Médicale Evaluation Recherche, Unité de recherche clinique, Lyon, France. 9. Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, The Netherlands. 10. Institut des Maladies de l'Appareil Digestif, CHU Nantes and Nantes University, Nantes, France. 11. iDigest Clinic and Laboratory for Disorders of GI Motility and Function, Division of Gastroenterology, University Hospital Zurich, Zurich, Switzerland. 12. Division of Gasotrenterology, Department of Medicine, Northwestern University, Chicago, IL, USA. 13. Division of Gastroenterology, Department of Medicine, University of California San Diego, San Diego, CA, USA. 14. Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy. 15. Department of Pathophysiology and Transplantation, Università degli Studi, Milan, Italy. 16. Division of Gastroenterology, Department of Surgical, Oncological and Gastroenterological Sciences, University of Padua, Padua, Italy. 17. Center for Digestive Diseases, Bart's and the London School and Dentistry, London, UK. 18. Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, China.
Abstract
BACKGROUND: Criteria for transient lower esophageal sphincter relaxations (TLESRs) are well-defined for Dentsleeve manometry. As high-resolution manometry (HRM) is now the gold standard to assess esophageal motility, our aim was to propose a consensus definition of TLESRs using HRM. METHODS: Postprandial esophageal HRM combined with impedance was performed in 10 patients with gastroesophageal reflux disease. Transient lower esophageal sphincter relaxations identification was performed by 17 experts using a Delphi process. Four investigators then characterized TLESR candidates that achieved 100% agreement (TLESR events) and those that achieved less than 25% agreement (non-events) after the third round. Logistic regression and decision tree analysis were used to define optimal diagnostic criteria. KEY RESULTS: All diagnostic criteria were more frequently encountered in the 57 TLESR events than in the 52 non-events. Crural diaphragm (CD) inhibition and LES relaxation duration >10 seconds had the highest predictive value to identify TLESR. Based on decision tree analysis, reflux on impedance, esophageal shortening, common cavity, upper esophageal sphincter relaxation without swallow and secondary peristalsis were alternate diagnostic criteria. CONCLUSION & INFERENCES: Using HRM, TLESR might be defined as LES relaxation occurring in absence of swallowing, lasting more than 10 seconds and associated with CD inhibition.
BACKGROUND: Criteria for transient lower esophageal sphincter relaxations (TLESRs) are well-defined for Dentsleeve manometry. As high-resolution manometry (HRM) is now the gold standard to assess esophageal motility, our aim was to propose a consensus definition of TLESRs using HRM. METHODS: Postprandial esophageal HRM combined with impedance was performed in 10 patients with gastroesophageal reflux disease. Transient lower esophageal sphincter relaxations identification was performed by 17 experts using a Delphi process. Four investigators then characterized TLESR candidates that achieved 100% agreement (TLESR events) and those that achieved less than 25% agreement (non-events) after the third round. Logistic regression and decision tree analysis were used to define optimal diagnostic criteria. KEY RESULTS: All diagnostic criteria were more frequently encountered in the 57 TLESR events than in the 52 non-events. Crural diaphragm (CD) inhibition and LES relaxation duration >10 seconds had the highest predictive value to identify TLESR. Based on decision tree analysis, reflux on impedance, esophageal shortening, common cavity, upper esophageal sphincter relaxation without swallow and secondary peristalsis were alternate diagnostic criteria. CONCLUSION & INFERENCES: Using HRM, TLESR might be defined as LES relaxation occurring in absence of swallowing, lasting more than 10 seconds and associated with CD inhibition.