Diagnostic performance of the endoscopic pressure study integrated system (EPSIS): a novel diagnostic tool for gastroesophageal reflux disease
submitted 29 October 2018
accepted after revision 15 April 2019
19 June 2019 (eFirst)
Background The endoscopic pressure study integrated system (EPSIS) is a prototypic system for monitoring intragastric pressure (IGP) fluctuations that result from opening of the cardia during gastric distension. The performance of EPSIS for the diagnosis of gastroesophageal reflux disease (GERD) was evaluated.
Methods A retrospective analysis was conducted of data prospectively collected over a 2-year period from 59 patients who underwent gastroscopy, EPSIS, and 24-hour pH monitoring. Using a dedicated electronic device and a through-the-scope catheter, maximum IGP (IGPmax) and IGP waveform pattern (uphill/flat) were recorded.
Results The optimal IGPmax cutoff was 18.7 mmHg. IGPmax < 18.7 mmHg (sensitivity 74.2 %, 95 % confidence interval [CI] 56.8 – 86.3; specificity 57.1 %, 95 %CI 39.1 – 73.5) and flat pattern (sensitivity 71.0 %, 95 %CI 53.4 – 83.9; specificity 82.1 %, 95 %CI 64.4 – 92.1) were associated with GERD. “Double” EPSIS positivity (IGPmax < 18.7 mmHg and flat pattern) provided maximum specificity (85.7 %, 95 %CI 68.5 – 94.3), whereas “any” EPSIS positivity (IGPmax < 18.7 mmHg or flat pattern) provided maximum sensitivity (80.6 %, 95 %CI 63.7 – 90.8). Maximum specificity and sensitivity for nonerosive reflux disease (NERD) was > 70 %. In multivariate analysis, “double” EPSIS positivity was the strongest predictor of GERD (odds ratio [OR] 16.05, 95 %CI 3.23 – 79.7) and NERD (OR 14.7, 95 %CI 2.37 – 90.8).
Conclusion EPSIS emerges as a reliable adjunct to routine gastroscopy for GERD diagnosis, and might prove helpful for the stratification and management of patients with reflux disorders.
- 1 Dent J, El-Serag HB, Wallander MA. et al. Epidemiology of gastro-oesophageal reflux disease: a systematic review. Gut 2005; 54: 710-717
- 2 Gyawali CP, Kahrilas PJ, Savarino E. et al. Modern diagnosis of GERD: the Lyon Consensus. Gut 2018; 67: 1351-1362
- 3 Vaezi MF, Pandolfino JE, Vela MF. et al. White paper AGA: Optimal strategies to define and diagnose gastroesophageal reflux disease. Clin Gastroenterol Hepatol 2017; 15: 1162-1172
- 4 Bredenoord AJ, Weusten BL, Timmer R. et al. Relationships between air swallowing, intragastric air, belching and gastro-oesophageal reflux. Neurogastroenterol Motil 2005; 17: 341-347
- 5 Holloway RH, Kocyan P, Dent J. Provocation of transient lower esophageal sphincter relaxations by meals in patients with symptomatic gastroesophageal reflux. Dig Dis Sci 1991; 36: 1034-1039
- 6 Holloway RH, Hongo M, Berger K. et al. Gastric distention: a mechanism for postprandial gastroesophageal reflux. Gastroenterology 1985; 89: 779-784
- 7 Hirano I, Richter JE. Practice Parameters Committee of the American College of Gastroenterology. ACG practice guidelines: Esophageal reflux testing. Am J Gastroenterol 2007; 102: 668-685
- 8 Hansdotter I, Björ O, Andreasson A. et al. Hill classification is superior to the axial length of a hiatal hernia for assessment of the mechanical anti-reflux barrier at the gastroesophageal junction. Endosc Int Open 2016; 4: E311-E317
- 9 Sifrim D, Holloway R. Transient lower esophageal sphincter relaxations: how many or how harmful?. Am J Gastroenterol 2001; 96: 2529-2532
- 10 Sifrim D, Holloway R, Silny J. et al. Composition of the postprandial refluxate in patients with gastroesophageal reflux disease. Am J Gastroenterol 2001; 96: 647-655
- 11 Kahrilas PJ, McColl K, Fox M. et al. The acid pocket: a target for treatment in reflux disease?. Am J Gastroenterol 2013; 108: 1058-1064
- 12 Yamasaki T, O’Neil J, Fass R. Update on functional heartburn. Gastroenterol Hepatol (NY) 2017; 13: 725-734
- 13 Yamasaki T, Fass R. Reflux hypersensitivity: a new functional esophageal disorder. J Neurogastroenterol Motil 2017; 23: 495-503
- 14 Pace F, Casini V, Pallotta S. Heterogeneity of endoscopy negative heartburn: epidemiology and natural history. World J Gastroenterol 2008; 14: 5233-5236
- 15 de Leon A, Ahlstrand R, Thörn SE. et al. Effects of propofol on oesophageal sphincters: a study on young and elderly volunteers using high-resolution solid-state manometry. Eur J Anaesthesiol 2011; 28: 273-278