Validation of criteria for the definition of transient lower esophageal sphincter relaxations using high‐resolution manometry
S. Roman
(1, 2, 3, 4)
,
R. Holloway
(5)
,
J. Keller
(6)
,
F. Herbella
(7)
,
F. Zerbib
(8)
,
Y. Xiao
(9, 10, 11)
,
Lorraine Bernard
(12, 3, 13)
,
A. Bredenoord
(14)
,
S. Bruley Des Varannes
(15, 16, 17)
,
M. Chen
(5)
,
M. Fox
(18)
,
P. Kahrilas
(19)
,
R. Mittal
,
R. Penagini
(20, 21)
,
E. Savarino
(22)
,
D. Sifrim
(23)
,
J. Wu
(24)
,
E. Decullier
(3)
,
J. Pandolfino
(19)
,
F. Mion
(3, 25, 4)
1
INS -
Institut de Neurosciences des Systèmes
2 INSERM - Institut National de la Santé et de la Recherche Médicale
3 HCL - Hospices Civils de Lyon
4 LabTAU - Application des ultrasons à la thérapie
5 Royal Adelaide Hospital [Adelaide Australia]
6 PSI - Paul Scherrer Institute
7 Unifesp - Federal University of Sao Paulo
8 Hôpital Haut-Lévêque [CHU Bordeaux]
9 AER - Atmospheric and Environmental Research, Inc.
10 Zhejiang University
11 SYSU - Sun Yat-sen University [Guangzhou]
12 Service de Biostatistiques [Lyon]
13 Département écologie évolutive [LBBE]
14 AMC - Academic Medical Center - Academisch Medisch Centrum [Amsterdam]
15 TENS - The Enteric Nervous System in gut and brain disorders [U1235]
16 CHU Nantes - Centre Hospitalier Universitaire de Nantes = Nantes University Hospital
17 Institut des Maladies de l'Appareil Digestif
18 Division of Gastroenterology, University Hospital Zurich, Zurich, Switzerland.
19 Northwestern University [Evanston]
20 Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico
21 UNIMI - Università degli Studi di Milano = University of Milan
22 Unipd - Università degli Studi di Padova = University of Padua
23 Bart's and The London School of Medicine and Dentistry
24 CUHK - The Chinese University of Hong Kong [Hong Kong]
25 UCBL - Université Claude Bernard Lyon 1
2 INSERM - Institut National de la Santé et de la Recherche Médicale
3 HCL - Hospices Civils de Lyon
4 LabTAU - Application des ultrasons à la thérapie
5 Royal Adelaide Hospital [Adelaide Australia]
6 PSI - Paul Scherrer Institute
7 Unifesp - Federal University of Sao Paulo
8 Hôpital Haut-Lévêque [CHU Bordeaux]
9 AER - Atmospheric and Environmental Research, Inc.
10 Zhejiang University
11 SYSU - Sun Yat-sen University [Guangzhou]
12 Service de Biostatistiques [Lyon]
13 Département écologie évolutive [LBBE]
14 AMC - Academic Medical Center - Academisch Medisch Centrum [Amsterdam]
15 TENS - The Enteric Nervous System in gut and brain disorders [U1235]
16 CHU Nantes - Centre Hospitalier Universitaire de Nantes = Nantes University Hospital
17 Institut des Maladies de l'Appareil Digestif
18 Division of Gastroenterology, University Hospital Zurich, Zurich, Switzerland.
19 Northwestern University [Evanston]
20 Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico
21 UNIMI - Università degli Studi di Milano = University of Milan
22 Unipd - Università degli Studi di Padova = University of Padua
23 Bart's and The London School of Medicine and Dentistry
24 CUHK - The Chinese University of Hong Kong [Hong Kong]
25 UCBL - Université Claude Bernard Lyon 1
Lorraine Bernard
- Fonction : Auteur
- PersonId : 747834
- IdHAL : lorraine-bernard
R. Mittal
- Fonction : Auteur
Résumé
Abstract Background Criteria for transient lower esophageal sphincter relaxations ( TLESR s) are well‐defined for Dentsleeve manometry. As high‐resolution manometry ( HRM ) is now the gold standard to assess esophageal motility, our aim was to propose a consensus definition of TLESR s using HRM . Methods Postprandial esophageal HRM combined with impedance was performed in 10 patients with gastroesophageal reflux disease. Transient lower esophageal sphincter relaxations identification was performed by 17 experts using a Delphi process. Four investigators then characterized TLESR candidates that achieved 100% agreement ( TLESR events) and those that achieved less than 25% agreement (non‐events) after the third round. Logistic regression and decision tree analysis were used to define optimal diagnostic criteria. Key Results All diagnostic criteria were more frequently encountered in the 57 TLESR events than in the 52 non‐events. Crural diaphragm ( CD ) inhibition and LES relaxation duration >10 seconds had the highest predictive value to identify TLESR . Based on decision tree analysis, reflux on impedance, esophageal shortening, common cavity, upper esophageal sphincter relaxation without swallow and secondary peristalsis were alternate diagnostic criteria. Conclusion & Inferences Using HRM , TLESR might be defined as LES relaxation occurring in absence of swallowing, lasting more than 10 seconds and associated with CD inhibition.