DOI: http://dx.doi.org/10.18203/2394-6040.ijcmph20214256

Non-erosive gastroesophageal reflux disease determination criteria by functional tests: a predictive model based on multivariate analysis

Raúl Aponte, Nefertiti Daulabani, Zuleyma de Jesús, Soberanía Rengifo, Luis Pérez-Ybarra

Abstract


Background: Gastroesophageal reflux disease (GERD) in 2009 presented a prevalence of 11.5% in Venezuela. It is a complex, multifactorial disease that is difficult to define, since it consists of several signs and symptoms that may or may not coexist together, both in the presence and absence of the disease.

Methods: A prospective study was conducted that consisted of a group of 85 patients diagnosed with non-erosive gastroesophageal reflux disease (NERD) and 20 asymptomatic volunteers. Functional tests were conducted on both groups that included high resolution manometry, 24-hour pH-metry - impedance study. The chi-square independence test, principal component analysis and multiple correspondence analysis were applied to identify which variables showed greater association and importance for the diagnosis of NERD.

Results: The results indicated that it is possible to establish a rapid diagnostic test based on the solid drink test, distal contraction index, peristaltic jumps and presence of heartburn with a sensitivity of 96% and specificity of 90%.

Conclusions: It is possible to establish a NERD rapid diagnostic test based on functional tests.


Keywords


Gastroesophageal reflux disease, Non-erosive gastroesophageal reflux disease, Functional tests, Clearance, Principal component analysis, Multiple correspondence analysis

Full Text:

PDF

References


Veitia G, Ruiz N, Armas V, Graterol A, Del Valle D, Mago E, et al. Prevalencia de enfermedad por reflujo gastroesofágico en la población adulta venezolana. Gen. 2009;63(3):170-3.

Vakil N, van Zanten SV, Kahrilas P, Dent J, Jones R. Global Consensus Group. The Montreal definition and classification of gastroesophageal reflux disease: a global evidence-based consensus. Am J Gastroenterol. 2006;101(8):1900-20.

Modlin IM, Hunt RH, Malfertheiner P, Moayyedi, Quigley EM, Tytgat GNJ, et al. Diagnosis and management of non-erosive reflux disease--the Vevey NERD Consensus Group. Digestion. 2009;80(2):74-88.

Dean BB, Gano Jr. AD, Knight K, Ofman JJ, Fass R. Effectiveness of proton pump inhibitors in non-erosive reflux disease. Clin Gastroenterol Hepatol. 2004;2(8):656-64.

El-Serag HB. Epidemiology of non-erosive reflux disease. Digestion. 2008;78(1):6-10.

Cicala M, Emerenziani S, Caviglia R, Guarino MPL, Vavassori P, Ribolsi M, et al. Intra-oesophageal distribution and perception of acid reflux in patients with non-erosive gastro-oesophageal reflux disease. Aliment Pharmacol Ther. 2003;18(6):605-13.

Bredenoord AJ, Hemmink GJM, Smout AJPM. Relationship between gastro-oesophageal reflux pattern and severity of mucosal damage. Neurogastroenterol Motil. 2009;21(8):807-12

Bulsiewicz WJ, Kahrilas PJ, Kwiatek MA, Ghosh SK, Meek A, Pandolfino JE. Esophageal pressure topography criteria indicative of incomplete bolus clearance: a study using high-resolution impedance manometry. Am J Gastroenterol. 2009;104(11):2721-8.

Ho SC, Chang CS, Wu CY, Chen GH. Ineffective esophageal motility is a primary motility disorder in gastroesophageal reflux disease. Dig Dis Sci. 2002;47(3):652-6.

Diener U, Patti MG, Molena D, Fisichella PM, Way LW. Esophageal dysmotility and gastroesophageal reflux disease. J Gastrointest Surg. 2001;5(3):260-5.

Ribolsi M, Balestrieri P, Emerenziani S, Guarino MPL, Cicala M. Weak peristalsis with large breaks is associated with higher acid exposure and delayed reflux clearance in the supine position in GERD patients. Am J Gastroenterol. 2014;109(1):46-51.

Savarino E, Gemignani L, Pohl D, Zentilin P, Dulbecco P, Assandri L, et al. Oesophageal motility and bolus transit abnormalities increase in parallel with the severity of gastro-oesophageal reflux disease. Aliment Pharmacol Ther. 2011;34(4):476-86.

Kahrilas PJ, Dodds WJ, Hogan WJ. Effect of peristaltic dysfunction on esophageal volume clearance. Gastroenterology. 1988;94(1):73-80.

Xu JY, Xie XP, Song GQ, Hou XH. Healing of severe reflux esophagitis with PPI does not improve esophageal dysmotility. Dis Esophagus. 2007;20(4):346-52.

Timmer R, Breumelhof R, Nadorp JH, Smout AJ. Oesophageal motility and gastro-oesophageal reflux before and after healing of reflux oesophagitis. A study using 24 hour ambulatory pH and pressure monitoring. Gut. 1994;35(11):1519-22.

Heider TR, Behrns KE, Koruda MJ, Shaheen NJ, Lucktong TA, Bradshaw B, et al. Fundoplication improve disordered esophageal motility. J Gastrointest Surg. 2003;7(2):159-63.

Aponte R, Cardozo A, Rejón L, Davila J, Echenique M, Cardozo MG. Evaluación funcional de la unión esófago gástrica por impedancia planimétrica antes y después de gastrectomía vertical en manga como factor predictor de enfermedad de reflujo gastro esofágico “de novo”. Comunicación preliminar. Gen. 2015;69(4):125-32.

Kahrilas PJ, Bredenoord AJ, Fox M, Gyawali CP, Roman S, Smout AJPM, et al. The Chicago classification of esophageal motility disorders, v3.0. Neurogastroenterol Motil. 2015;27(2):160-74.

Kahrilas PJ, Kim HC, Pandolfino JE. Approaches to the diagnosis and grading of hiatal hernia. Best Pract Res Clin Gastroenterol. 2008;22(4):601-16.

Trudgill NJ, Sifrim D, Sweis R, Fullard M, Basu K, McCord M, et al. British Society of Gastroenterology guidelines for oesophageal manometry and oesophageal reflux monitoring. Gut. 2019;68(10):1731-50.

Nian YY, Feng C, Jing FC, Wang XQ, Zhang J. Reflux characteristics of 113 GERD patients with abnormal 24-h multichannel intraluminal impedance-pH tests. J Zhejiang Univ Sci B. 2015;16(9):805-10.

Gyawali CP, Bredenoord AJ, Conklin JL, Fox M, Pandolfino JE, Peters JH, et al. Evaluation of esophageal motor function in clinical practice. Neurogastroenterol Motil. 2013;25(2):99-133.

Porter RF, Kumar N, Drapekin JE, Gyawali CP. Fragmented esophageal smooth muscle contraction segments on high resolution manometry: a marker of esophageal hypomotility. Neurogastroenterol Motil. 2012;24(8):763-8.

Martinucci I, Savarino EV, Pandolfino JE, Russo S, Bellini M, Tolone S, et al. Vigor of peristalsis during multiple rapid swallows is inversely correlated with acid exposure time in patients with NERD. Neurogastroenterol Motil. 2016;28(2):243-50.

Fornari F, Bravi I, Penagini R, Tack J, Sifrim D. Multiple rapid swallowing: a complementary test during standard oesophageal manometry. Neurogastroenterol Motil. 2009;21(7):718-e41.

Price LH, Li Y, Patel A, Gyawali CP. Reproducibility patterns of multiple rapid swallows during high resolution esophageal manometry provide insights into esophageal pathophysiology. Neurogastroenterol Motil. 2014;26(5):646-53.

Gyawali CP, Kahrilas PJ, Savarino E, Zerbib F, Mion F, Smout AJPM, et al. Modern diagnosis of GERD: the Lyon Consensus. Gut. 2018;67(7):1351-62.