Abstract：
BACKGROUND: High-resolution manometry (HRM) tools, like esophagogastric junction contractile integral (EGJ-CI), assess EGJ barrier function.
OBJECTIVE: This study aimed to evaluate the relationships between manometric EGJ metrics with esophageal acid exposure.
METHODS: We conducted a retrospective review of 284 patients who underwent HRM and ambulatory reflux testing between 11/2017-1/2020. EGJ-CI and total-EGJ-CI were manually calculated. Pathologic acid exposure was defined as pH < 4 with esophageal acid exposure time (EAET) exceeding 6.0%. Pearson\'s correlation, univariable and multivariable regression models were utilized to assess the relationships between pathologic acid exposure and EGJ parameters. Sensitivity and specificity thresholds for EGJ-CI and total EGJ-CI were optimized with ROC analyses.
RESULTS: On univariable analysis, patients with pathologic acid exposure had increased odds of having lower mean basal LES pressures, EGJ-CI, and total EGJ-CI than patients without pathologic acid exposure. On multivariable analysis, age, EGJ-CI and mean DCI were significant predictors of pathologic acid exposure. There were significant, though weak, correlations between EAET and EGJ-CI and total EGJ-CI (r = - 0.18, - 0.19, p < 0.01, respectively). An EGJ-CI cutoff of 44.16 as a predictor for pathologic acid exposure had a sensitivity of 46% and specificity of 42% (AUC 0.60). Total EGJ-CI cutoff of 11,461.3 for pathologic acid exposure had a sensitivity of 44% and a specificity of 43% (AUC 0.62).
CONCLUSIONS: EGJ-CI can independently predict pathologic acid exposure. However, the poor correlation between EGJ-CI and acid exposure, as well as the low sensitivity and specificity of calculated thresholds, indicate that mechanisms other than EGJ barrier function may impact acid exposure.
OBJECTIVE: This study aimed to evaluate the relationships between manometric EGJ metrics with esophageal acid exposure.
METHODS: We conducted a retrospective review of 284 patients who underwent HRM and ambulatory reflux testing between 11/2017-1/2020. EGJ-CI and total-EGJ-CI were manually calculated. Pathologic acid exposure was defined as pH < 4 with esophageal acid exposure time (EAET) exceeding 6.0%. Pearson\'s correlation, univariable and multivariable regression models were utilized to assess the relationships between pathologic acid exposure and EGJ parameters. Sensitivity and specificity thresholds for EGJ-CI and total EGJ-CI were optimized with ROC analyses.
RESULTS: On univariable analysis, patients with pathologic acid exposure had increased odds of having lower mean basal LES pressures, EGJ-CI, and total EGJ-CI than patients without pathologic acid exposure. On multivariable analysis, age, EGJ-CI and mean DCI were significant predictors of pathologic acid exposure. There were significant, though weak, correlations between EAET and EGJ-CI and total EGJ-CI (r = - 0.18, - 0.19, p < 0.01, respectively). An EGJ-CI cutoff of 44.16 as a predictor for pathologic acid exposure had a sensitivity of 46% and specificity of 42% (AUC 0.60). Total EGJ-CI cutoff of 11,461.3 for pathologic acid exposure had a sensitivity of 44% and a specificity of 43% (AUC 0.62).
CONCLUSIONS: EGJ-CI can independently predict pathologic acid exposure. However, the poor correlation between EGJ-CI and acid exposure, as well as the low sensitivity and specificity of calculated thresholds, indicate that mechanisms other than EGJ barrier function may impact acid exposure.
摘要：
背景：高分辨率测压（HRM）工具，如食管胃交界处收缩积分(EGJ-CI)，评估EGJ屏障功能。
目的：本研究旨在评估食管胃酸暴露与心电图测量之间的关系。
方法：我们对2017年11月至2020年1月接受HRM和动态反流测试的284例患者进行了回顾性研究。手动计算EGJ-CI和总EGJ-CI。病理性酸暴露定义为pH<4，食管酸暴露时间（EAET）超过6.0％。皮尔森的相关性，使用单变量和多变量回归模型评估病理酸暴露与EGJ参数之间的关系.用ROC分析优化EGJ-CI和总EGJ-CI的敏感性和特异性阈值。
结果：关于单变量分析，病理性酸暴露的患者平均基础LES压力降低的几率增加，EGJ-CI和总EGJ-CI比没有病理性酸暴露的患者。在多变量分析中，年龄,EGJ-CI和平均DCI是病理酸暴露的重要预测因子。有显著的,虽然虚弱,EAET和EGJ-CI与总EGJ-CI之间的相关性（分别为r=-0.18，-0.19，p<0.01）。作为病理性酸暴露的预测因子的EGJ-CI临界值为44.16，其敏感性为46％，特异性为42％（AUC0.60）。病理酸暴露的总EGJ-CI截断值为11,461.3，敏感性为44％，特异性为43％（AUC0.62）。
结论：EGJ-CI可独立预测病理酸暴露。然而,EGJ-CI与酸暴露之间的相关性较差，以及计算阈值的低灵敏度和特异性，表明EGJ屏障功能以外的机制可能会影响酸暴露。
目的：本研究旨在评估食管胃酸暴露与心电图测量之间的关系。
方法：我们对2017年11月至2020年1月接受HRM和动态反流测试的284例患者进行了回顾性研究。手动计算EGJ-CI和总EGJ-CI。病理性酸暴露定义为pH<4，食管酸暴露时间（EAET）超过6.0％。皮尔森的相关性，使用单变量和多变量回归模型评估病理酸暴露与EGJ参数之间的关系.用ROC分析优化EGJ-CI和总EGJ-CI的敏感性和特异性阈值。
结果：关于单变量分析，病理性酸暴露的患者平均基础LES压力降低的几率增加，EGJ-CI和总EGJ-CI比没有病理性酸暴露的患者。在多变量分析中，年龄,EGJ-CI和平均DCI是病理酸暴露的重要预测因子。有显著的,虽然虚弱,EAET和EGJ-CI与总EGJ-CI之间的相关性（分别为r=-0.18，-0.19，p<0.01）。作为病理性酸暴露的预测因子的EGJ-CI临界值为44.16，其敏感性为46％，特异性为42％（AUC0.60）。病理酸暴露的总EGJ-CI截断值为11,461.3，敏感性为44％，特异性为43％（AUC0.62）。
结论：EGJ-CI可独立预测病理酸暴露。然而,EGJ-CI与酸暴露之间的相关性较差，以及计算阈值的低灵敏度和特异性，表明EGJ屏障功能以外的机制可能会影响酸暴露。
