PDF herunterladen
Endoscopy 2019; 51(08): 759-762
DOI: 10.1055/a-0938-2777
Innovations and brief communications
© Georg Thieme Verlag KG Stuttgart · New York

Diagnostic performance of the endoscopic pressure study integrated system (EPSIS): a novel diagnostic tool for gastroesophageal reflux disease

Haruhiro Inoue
1   Digestive Diseases Center, Showa University Koto Toyosu Hospital, Showa University, Tokyo, Japan
,
Yuto Shimamura
1   Digestive Diseases Center, Showa University Koto Toyosu Hospital, Showa University, Tokyo, Japan
,
Enrique Rodriguez de Santiago
1   Digestive Diseases Center, Showa University Koto Toyosu Hospital, Showa University, Tokyo, Japan
,
Yasutoshi Kobayashi
2   Division of Gastroenterology, Jichi Medical University, Tochigi, Japan
,
Masaki Ominami
1   Digestive Diseases Center, Showa University Koto Toyosu Hospital, Showa University, Tokyo, Japan
,
Yusuke Fujiyoshi
1   Digestive Diseases Center, Showa University Koto Toyosu Hospital, Showa University, Tokyo, Japan
,
Kazuya Sumi
1   Digestive Diseases Center, Showa University Koto Toyosu Hospital, Showa University, Tokyo, Japan
,
Haruo Ikeda
1   Digestive Diseases Center, Showa University Koto Toyosu Hospital, Showa University, Tokyo, Japan
,
Manabu Onimaru
1   Digestive Diseases Center, Showa University Koto Toyosu Hospital, Showa University, Tokyo, Japan
,
Anastassios C. Manolakis
1   Digestive Diseases Center, Showa University Koto Toyosu Hospital, Showa University, Tokyo, Japan
› Institutsangaben
Weitere Informationen

Publikationsverlauf

submitted 29. Oktober 2018

accepted after revision 15. April 2019

Publikationsdatum:
19. Juni 2019 (online)

Auch verfügbar auf
    Lizenzen und Reprints

Abstract

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.

Tables 1s – 3s, Figs. 1s, 2s

 

  • References

  • 1 Dent J, El-Serag HB, Wallander MA. et al. Epidemiology of gastro-oesophageal reflux disease: a systematic review. Gut 2005; 54: 710-717
    CrossrefPubMedGoogle Scholar
  • 2 Gyawali CP, Kahrilas PJ, Savarino E. et al. Modern diagnosis of GERD: the Lyon Consensus. Gut 2018; 67: 1351-1362
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 6 Holloway RH, Hongo M, Berger K. et al. Gastric distention: a mechanism for postprandial gastroesophageal reflux. Gastroenterology 1985; 89: 779-784
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 9 Sifrim D, Holloway R. Transient lower esophageal sphincter relaxations: how many or how harmful?. Am J Gastroenterol 2001; 96: 2529-2532
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 12 Yamasaki T, O’Neil J, Fass R. Update on functional heartburn. Gastroenterol Hepatol (NY) 2017; 13: 725-734
    PubMedGoogle Scholar
  • 13 Yamasaki T, Fass R. Reflux hypersensitivity: a new functional esophageal disorder. J Neurogastroenterol Motil 2017; 23: 495-503
    CrossrefPubMedGoogle Scholar
  • 14 Pace F, Casini V, Pallotta S. Heterogeneity of endoscopy negative heartburn: epidemiology and natural history. World J Gastroenterol 2008; 14: 5233-5236
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar