Oesophageal pressure topographic metrics in refractory gastroesophageal reflux disease: An Indian perspective

Gastroesophageal reflux disease (GERD) is usually caused by dysfunction of the lower oesophageal sphincter (LES). However, abnormal patterns of oesophageal motility, such as ineffective oesophageal motility (IEM) or absent peristalsis, leading to impaired oesophageal clearance may also cause or aggravate GERD, leading to refractoriness to treatment. The objective of this study was to analyse oesophageal topographic metrics in patients presenting with symptoms of GERD, refractory to treatment. A retrospective analysis of 30 patients who presented with refractory heartburn/regurgitation of 06 months–03 years duration was done. pH metry (DeMeester score) was analysed. Sixteen channel high-resolution manometry (HRM) was used to study the oesophageal motility. Basal LES pressure (BLESP), integrated relaxation pressure (IRP) and 5 mL water swallows were assessed to determine the type of oesophageal peristalsis based on Chicago Classification version 4.0. The Statistical Package for the Social Sciences version 20 was used to analyse the data. Descriptive statistics such as percentage, mean, and standard deviation were reported. Karl-Pearson’s correlation was used to determine the correlation between age, BLESP and IRP. On analysis of 30 patients, 14 (46.66%) patients were found to have normal LES pressure and normal peristaltic wave, 07 (23.33%) patients showed hypotensive LES with normal peristaltic wave, and 09 (30%) were found to have IEM. About one-third of patients in our study showed IEM. HRM must be considered in patients with GERD, especially those who are refractory to treatment.