Benjamin D Rogers1, Arvind Rengarajan1, Luiz Abrahao2, Shobna Bhatia3, Serhat Bor4, Dustin A Carlson5, Daniel Cisternas6, Sutep Gonlachanvit7, Albis Hani8, Jamal Hayat9, Osamu Kawamura10, Yeung Yeh Lee11,12, Ana Maria Leguizamo8, Ans Pauwels13, Julio Perez de la Serna14, Rosa I Ramos15, Jose Maria Remes-Troche16, Sabine Roman17,18, Edoardo Savarino19, Jordi Serra20, Daniel Sifrim21, Salvatore Tolone22, Zhiqin Wong12, Frank Zerbib23, John Pandolfino5, C Prakash Gyawali1. 1. Division of Gastroenterology, Washington University School of Medicine, St Louis, MO, USA. 2. University Hospital Clementino Fraga Filho, Rio de Janeiro, Brazil. 3. Department of Gastroenterology, Sir HN Reliance Foundation Hospital, Mumbai, India. 4. Department of Gastroenterology, Ege University, Izmir, Turkey. 5. Division of Gastroenterology and Hepatology, Northwestern University, Chicago, IL, USA. 6. Clínica Alemana de Santiago, Facultad de Medicina, Universidad del Desarrollo, Santiago de Chile, Chile. 7. Center of Excellence on Neurogastroenterology and Motility, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand. 8. Departamento de Gastroenterología y Laboratorio de Motilidad, Hospital Universitario San Ignacio, Pontificia Universidad Javeriana, Bogotá, Colombia. 9. Department of Gastroenterology, St. George's University Hospitals NHS Trust, London, UK. 10. Department of Gastroenterology, Kamimoku SPA Hospital, Minakami, Gunma, Japan. 11. School of Medical Sciences, Universiti Sains Malaysia, Kota Bharu, Malaysia. 12. Gut Research Group, Faculty of Medicine, National University of Malaysia, Kuala Lumpur, Malaysia. 13. Department of Gastroenterology, Catholic University of Leuven, Leuven, Belgium. 14. Unidad de Motilidad, Servicio de Aparto Digestivo, Hospital Clinico San Carlos, Madrid, Spain. 15. Motility Lab, Department of Gastroenterology, British Hospital and El Cruce Hospital, Buenos Aires, Argentina. 16. Digestive Physiology and Motility Lab, Medical Biological Research Institute, Universidad Veracruzana, Veracruz, México. 17. Digestive Physiology, Hospices Civils de Lyon, Hopital E Herriot, Université de Lyon, Lyon, France. 18. Digestive Physiology, Université de Lyon, Lyon I University, Lyon, France. 19. Division of Gastroenterology, Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy. 20. Motility and Functional Gut Disorders Unit, University Hospital Germans Trias I Pujol. CIBERehd, Badalona, Barcelona, Spain. 21. Upper GI Physiology Unit, Barts and the London School of Medicine and Dentistry, London, UK. 22. General, Mininvasive and Bariatric Surgery Unit, University of Campania Luigi Vanvitelli, Naples, Italy. 23. CHU de Bordeaux, Centre Medico-Chirurgical Magellan, Hôpital Haut-Lévêque, Gastroenterology Department, Université de Bordeaux, Bordeaux, France.
Abstract
BACKGROUND: Esophagogastric junction contractile integral (EGJ-CI) and EGJ morphology are high-resolution manometry (HRM) metrics that assess EGJ barrier function. Normative data standardized across world regions and HRM manufacturers are limited. METHODS: Our aim was to determine normative EGJ metrics in a large international cohort of healthy volunteers undergoing HRM (Medtronic, Laborie, and Diversatek software) acquired from 16 countries in four world regions. EGJ-CI was calculated by the same two investigators using a distal contractile integral-like measurement across the EGJ for three respiratory cycles and corrected for respiration (mm Hg cm), using manufacturer-specific software tools. EGJ morphology was designated according to Chicago Classification v3.0. Median EGJ-CI values were calculated across age, genders, HRM systems, and regions. RESULTS: Of 484 studies (28.0 years, 56.2% F, 60.7% Medtronic studies, 26.0% Laborie, and 13.2% Diversatek), EGJ morphology was type 1 in 97.1%. Median EGJ-CI was similar between Medtronic (37.0 mm Hg cm, IQR 23.6-53.7 mm Hg cm) and Diversatek (34.9 mm Hg cm, IQR 22.1-56.1 mm Hg cm, P = 0.87), but was significantly higher using Laborie equipment (56.5 mm Hg cm, IQR 35.0-75.3 mm Hg cm, P < 0.001). 5th percentile EGJ-CI values ranged from 6.9 to 12.1 mm Hg cm. EGJ-CI values were consistent across world regions, but different between manufacturers even within the same world region (P ≤ 0.001). Within Medtronic studies, EGJ-CI and basal LESP were similar in younger and older individuals (P ≥ 0.3) but higher in women (P < 0.001). CONCLUSIONS: EGJ morphology is predominantly type 1 in healthy adults. EGJ-CI varies widely in health, with significant gender influence, but is consistent within each HRM system. Manufacturer-specific normative values should be utilized for clinical HRM interpretation.
BACKGROUND: Esophagogastric junction contractile integral (EGJ-CI) and EGJ morphology are high-resolution manometry (HRM) metrics that assess EGJ barrier function. Normative data standardized across world regions and HRM manufacturers are limited. METHODS: Our aim was to determine normative EGJ metrics in a large international cohort of healthy volunteers undergoing HRM (Medtronic, Laborie, and Diversatek software) acquired from 16 countries in four world regions. EGJ-CI was calculated by the same two investigators using a distal contractile integral-like measurement across the EGJ for three respiratory cycles and corrected for respiration (mm Hg cm), using manufacturer-specific software tools. EGJ morphology was designated according to Chicago Classification v3.0. Median EGJ-CI values were calculated across age, genders, HRM systems, and regions. RESULTS: Of 484 studies (28.0 years, 56.2% F, 60.7% Medtronic studies, 26.0% Laborie, and 13.2% Diversatek), EGJ morphology was type 1 in 97.1%. Median EGJ-CI was similar between Medtronic (37.0 mm Hg cm, IQR 23.6-53.7 mm Hg cm) and Diversatek (34.9 mm Hg cm, IQR 22.1-56.1 mm Hg cm, P = 0.87), but was significantly higher using Laborie equipment (56.5 mm Hg cm, IQR 35.0-75.3 mm Hg cm, P < 0.001). 5th percentile EGJ-CI values ranged from 6.9 to 12.1 mm Hg cm. EGJ-CI values were consistent across world regions, but different between manufacturers even within the same world region (P ≤ 0.001). Within Medtronic studies, EGJ-CI and basal LESP were similar in younger and older individuals (P ≥ 0.3) but higher in women (P < 0.001). CONCLUSIONS: EGJ morphology is predominantly type 1 in healthy adults. EGJ-CI varies widely in health, with significant gender influence, but is consistent within each HRM system. Manufacturer-specific normative values should be utilized for clinical HRM interpretation.
Authors: C P Gyawali; S Roman; A J Bredenoord; M Fox; J Keller; J E Pandolfino; D Sifrim; R Tatum; R Yadlapati; E Savarino Journal: Neurogastroenterol Motil Date: 2017-05-24 Impact factor: 3.598
Authors: P J Kahrilas; A J Bredenoord; M Fox; C P Gyawali; S Roman; A J P M Smout; J E Pandolfino Journal: Neurogastroenterol Motil Date: 2014-12-03 Impact factor: 3.598
Authors: S Tolone; N De Bortoli; E Marabotto; C de Cassan; G Bodini; S Roman; M Furnari; V Savarino; L Docimo; E Savarino Journal: Neurogastroenterol Motil Date: 2015-07-30 Impact factor: 3.598
Authors: Charles Cock; Laura K Besanko; Carly M Burgstad; Alison Thompson; Stamatiki Kritas; Richard Heddle; Robert Jl Fraser; Taher I Omari Journal: World J Gastroenterol Date: 2017-04-21 Impact factor: 5.742
Authors: Rena Yadlapati; Peter J Kahrilas; Mark R Fox; Albert J Bredenoord; C Prakash Gyawali; Sabine Roman; Arash Babaei; Ravinder K Mittal; Nathalie Rommel; Edoardo Savarino; Daniel Sifrim; André Smout; Michael F Vaezi; Frank Zerbib; Junichi Akiyama; Shobna Bhatia; Serhat Bor; Dustin A Carlson; Joan W Chen; Daniel Cisternas; Charles Cock; Enrique Coss-Adame; Nicola de Bortoli; Claudia Defilippi; Ronnie Fass; Uday C Ghoshal; Sutep Gonlachanvit; Albis Hani; Geoffrey S Hebbard; Kee Wook Jung; Philip Katz; David A Katzka; Abraham Khan; Geoffrey Paul Kohn; Adriana Lazarescu; Johannes Lengliner; Sumeet K Mittal; Taher Omari; Moo In Park; Roberto Penagini; Daniel Pohl; Joel E Richter; Jordi Serra; Rami Sweis; Jan Tack; Roger P Tatum; Radu Tutuian; Marcelo F Vela; Reuben K Wong; Justin C Wu; Yinglian Xiao; John E Pandolfino Journal: Neurogastroenterol Motil Date: 2021-01 Impact factor: 3.598