Esophagogastric junction contractile integral abnormalities in patients with proton pump inhibitor‐refractory symptoms

Background The esophagogastric junction contractile index (EGJ-CI) is a novel indicator to quantitatively evaluate the esophagogastric junction (EGJ) barrier function. Our aim was to assess the role of EGJ-CI in patients with intractable gastroesophageal reflux disease (GERD) symptoms and the correlation between EGJ-CI and the impedance-pH monitoring characteristics. Methods Eighty-two patients with proton pump inhibitor (PPI)-refractory symptoms (heartburn and/or regurgitation) were enrolled. These patients were divided into 2 groups based on the EGJ-CI value (39mmHg∙cm). Mean nocturnal baseline impedance (MNBI) was measured to explore its association with EGJ-CI. Results Median EGJ-CI value in patients with PPI-refractory symptoms was 30.8mmHg∙cm. There was a negative correlation between EGJ-CI and acid exposure time, reflux episodes, while a positive one between EGJ-CI and MNBI, distal contractile integral (DCI), lower esophageal sphincter basal pressure (LESP) as well as integrated relaxation pressure (IRP). According to EGJ-CI values, patients were classified as high EGJ-CI (n = 27) and low EGJ-CI group (n = 55). Patients with low EGJ-CI also had lower MNBI level than those with high EGJ-CI (2703 Ω vs 3545 Ω, P = 0.034). Conclusion In patients with PPI-intractable symptoms, EGJ-CI is clearly associated with acid exposure and conventional HRM parameters. This promising metric might provide significant evidence of esophageal motility and play an important role in the diagnosis and treatment of patients with refractory GERD.