Classification of esophageal motor findings in gastro-esophageal reflux disease: Conclusions from an international consensus group

the International GERD Consensus Working Group

Research output: Contribution to journalReview article

52 Citations (Scopus)

Abstract

Background: High-resolution manometry (HRM) has resulted in new revelations regarding the pathophysiology of gastro-esophageal reflux disease (GERD). The impact of new HRM motor paradigms on reflux burden needs further definition, leading to a modern approach to motor testing in GERD. Methods: Focused literature searches were conducted, evaluating pathophysiology of GERD with emphasis on HRM. The results were discussed with an international group of experts to develop a consensus on the role of HRM in GERD. A proposed classification system for esophageal motor abnormalities associated with GERD was generated. Key Results: Physiologic gastro-esophageal reflux is inherent in all humans, resulting from transient lower esophageal sphincter (LES) relaxations that allow venting of gastric air in the form of a belch. In pathological gastro-esophageal reflux, transient LES relaxations are accompanied by reflux of gastric contents. Structural disruption of the esophagogastric junction (EGJ) barrier, and incomplete clearance of the refluxate can contribute to abnormally high esophageal reflux burden that defines GERD. Esophageal HRM localizes the LES for pH and pH-impedance probe placement, and assesses esophageal body peristaltic performance prior to invasive antireflux therapies and antireflux surgery. Furthermore, HRM can assess EGJ and esophageal body mechanisms contributing to reflux, and exclude conditions that mimic GERD. Conclusions & Inferences: Structural and motor EGJ and esophageal processes contribute to the pathophysiology of GERD. A classification scheme is proposed incorporating EGJ and esophageal motor findings, and contraction reserve on provocative tests during HRM.

Original languageEnglish (US)
Article numbere13104
JournalNeurogastroenterology and Motility
Volume29
Issue number12
DOIs
StatePublished - Dec 1 2017

Fingerprint

Esophageal Diseases
Gastroesophageal Reflux
Manometry
Esophagogastric Junction
Lower Esophageal Sphincter
Gastrointestinal Contents
Electric Impedance
Stomach

Keywords

  • esophageal hypomotility
  • gastro-esophageal reflux disease
  • hiatus hernia

ASJC Scopus subject areas

  • Physiology
  • Endocrine and Autonomic Systems
  • Gastroenterology

Cite this

Classification of esophageal motor findings in gastro-esophageal reflux disease : Conclusions from an international consensus group. / the International GERD Consensus Working Group.

In: Neurogastroenterology and Motility, Vol. 29, No. 12, e13104, 01.12.2017.

Research output: Contribution to journalReview article

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title = "Classification of esophageal motor findings in gastro-esophageal reflux disease: Conclusions from an international consensus group",
abstract = "Background: High-resolution manometry (HRM) has resulted in new revelations regarding the pathophysiology of gastro-esophageal reflux disease (GERD). The impact of new HRM motor paradigms on reflux burden needs further definition, leading to a modern approach to motor testing in GERD. Methods: Focused literature searches were conducted, evaluating pathophysiology of GERD with emphasis on HRM. The results were discussed with an international group of experts to develop a consensus on the role of HRM in GERD. A proposed classification system for esophageal motor abnormalities associated with GERD was generated. Key Results: Physiologic gastro-esophageal reflux is inherent in all humans, resulting from transient lower esophageal sphincter (LES) relaxations that allow venting of gastric air in the form of a belch. In pathological gastro-esophageal reflux, transient LES relaxations are accompanied by reflux of gastric contents. Structural disruption of the esophagogastric junction (EGJ) barrier, and incomplete clearance of the refluxate can contribute to abnormally high esophageal reflux burden that defines GERD. Esophageal HRM localizes the LES for pH and pH-impedance probe placement, and assesses esophageal body peristaltic performance prior to invasive antireflux therapies and antireflux surgery. Furthermore, HRM can assess EGJ and esophageal body mechanisms contributing to reflux, and exclude conditions that mimic GERD. Conclusions & Inferences: Structural and motor EGJ and esophageal processes contribute to the pathophysiology of GERD. A classification scheme is proposed incorporating EGJ and esophageal motor findings, and contraction reserve on provocative tests during HRM.",
keywords = "esophageal hypomotility, gastro-esophageal reflux disease, hiatus hernia",
author = "{the International GERD Consensus Working Group} and Gyawali, {C. P.} and S. Roman and Bredenoord, {A. J.} and M. Fox and J. Keller and Pandolfino, {J. E.} and D. Sifrim and R. Tatum and R. Yadlapati and E. Savarino and Fernando Azpiroz and Arash Babaei and Shobna Bhatia and Guy Boeckxstaens and Serhat Bor and Dustin Carlson and Donald Castell and Michele Cicala and John Clarke and {De Bortoli}, Nicola and Vasile Drug and Marzio Frazzoni and Richard Holloway and Peter Kahrilas and Arne Kandulski and Phil Katz and David Katzka and Katzka, {David A} and Francois Mion and Luis Novais and Amit Patel and Roberto Penagini and Mentore Ribolsi and Joel Richter and Renato Salvador and Vincenzo Savarino and Jordi Serra and Felice Schnoll-Sussman and Andre Smout and Edy Soffer and Rami Sweis and Jan Tack and Salvatore Tolone and Radu Tutuian and Michael Vaezi and Marcelo Vela and Philip Woodland and Justin Wu and Yinglian Xiao and Frank Zerbib",
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T1 - Classification of esophageal motor findings in gastro-esophageal reflux disease

T2 - Conclusions from an international consensus group

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AU - Gyawali, C. P.

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AU - Bredenoord, A. J.

AU - Fox, M.

AU - Keller, J.

AU - Pandolfino, J. E.

AU - Sifrim, D.

AU - Tatum, R.

AU - Yadlapati, R.

AU - Savarino, E.

AU - Azpiroz, Fernando

AU - Babaei, Arash

AU - Bhatia, Shobna

AU - Boeckxstaens, Guy

AU - Bor, Serhat

AU - Carlson, Dustin

AU - Castell, Donald

AU - Cicala, Michele

AU - Clarke, John

AU - De Bortoli, Nicola

AU - Drug, Vasile

AU - Frazzoni, Marzio

AU - Holloway, Richard

AU - Kahrilas, Peter

AU - Kandulski, Arne

AU - Katz, Phil

AU - Katzka, David

AU - Katzka, David A

AU - Mion, Francois

AU - Novais, Luis

AU - Patel, Amit

AU - Penagini, Roberto

AU - Ribolsi, Mentore

AU - Richter, Joel

AU - Salvador, Renato

AU - Savarino, Vincenzo

AU - Serra, Jordi

AU - Schnoll-Sussman, Felice

AU - Smout, Andre

AU - Soffer, Edy

AU - Sweis, Rami

AU - Tack, Jan

AU - Tolone, Salvatore

AU - Tutuian, Radu

AU - Vaezi, Michael

AU - Vela, Marcelo

AU - Woodland, Philip

AU - Wu, Justin

AU - Xiao, Yinglian

AU - Zerbib, Frank

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N2 - Background: High-resolution manometry (HRM) has resulted in new revelations regarding the pathophysiology of gastro-esophageal reflux disease (GERD). The impact of new HRM motor paradigms on reflux burden needs further definition, leading to a modern approach to motor testing in GERD. Methods: Focused literature searches were conducted, evaluating pathophysiology of GERD with emphasis on HRM. The results were discussed with an international group of experts to develop a consensus on the role of HRM in GERD. A proposed classification system for esophageal motor abnormalities associated with GERD was generated. Key Results: Physiologic gastro-esophageal reflux is inherent in all humans, resulting from transient lower esophageal sphincter (LES) relaxations that allow venting of gastric air in the form of a belch. In pathological gastro-esophageal reflux, transient LES relaxations are accompanied by reflux of gastric contents. Structural disruption of the esophagogastric junction (EGJ) barrier, and incomplete clearance of the refluxate can contribute to abnormally high esophageal reflux burden that defines GERD. Esophageal HRM localizes the LES for pH and pH-impedance probe placement, and assesses esophageal body peristaltic performance prior to invasive antireflux therapies and antireflux surgery. Furthermore, HRM can assess EGJ and esophageal body mechanisms contributing to reflux, and exclude conditions that mimic GERD. Conclusions & Inferences: Structural and motor EGJ and esophageal processes contribute to the pathophysiology of GERD. A classification scheme is proposed incorporating EGJ and esophageal motor findings, and contraction reserve on provocative tests during HRM.

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KW - esophageal hypomotility

KW - gastro-esophageal reflux disease

KW - hiatus hernia

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DO - 10.1111/nmo.13104

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