Validation of HRM Score for the GERD Diagnosis (HRM nomogram)

University of Milan, Medical University of Vienna, Washington University School of Medicine, University of Pisa, Swedish Medical Center, Hospital Universiti Sains Malaysia, University of Campania "Luigi Vanvitelli", Universita degli Studi di Genova, Jikei University School of Medicine, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, University of Athens

The goal of this prospective study is to validate a high resolution manometry score to predict pathologic GERD in patients with reflux symptoms. The main question it aims to answer is: Is it possible to predict GERD on high resolution manometry? Participants will be asked to undergo high resolution manometry and pH-study

According to recent guidelines, high resolution manometry (HRM) has an ancillary role in the diagnosis of gastro-esophageal reflux disease (GERD). A recent multicenter study demonstrated the effectiveness of the straight leg raise (SLR) maneuver in predicting GERD, thus increasing the diagnostic value of HRM in patients with suspected pathological reflux. HRM parameters associated with GERD include esophageal body hypomotility such as ineffective esophageal motility (IEM), and esophagogastric junction (EGJ) metrics, particularly the EGJ contractile integral (EGJ-CI) that takes into consideration the presence or absence of a hiatal hernia (HH), and a hypotensive lower esophageal sphincter (LES). The combination of these four parameters might help to predict or exclude true GERD in patients undergoing HRM with the suspicion of GERD. In this multicenter international prospective study, we aimed to build a score to predict pathological esophageal acid exposure time (AET>6%).

High Resolution Manometry, Gastroesophageal reflux disease, Esophagogastric junction, Inta-abdominal pressure, Straight leg raise maneuver

HRM score is based on EJG type, ineffective esophageal motility, straight leg raise maneuver and EGJ contractile integral

Inclusion Criteria: HRM and wireless pH-study or catheter pH-impedance study performed for persistent GERD symptoms off proton-pump inhibitor (PPI) within two weeks of each other, SLR maneuver performed at the end of HRM Exclusion Criteria: Body mass index (BMI) >35 Kg/m2 prior esophageal surgery paraesophageal hiatal hernia eosinophilic esophagitis scleroderma esophageal achalasia

Siboni S, Kristo I, Rogers BD, De Bortoli N, Hobson A, Louie B, Lee YY, Tee V, Tolone S, Marabotto E, Visaggi P, Haworth J, Ivy M, Greenan G, Facchini C, Masuda T, Yano F, Perry K, Balasubramanian G, Theodorou D, Triantafyllou T, Cusmai L, Boveri S, Schoppmann SF, Gyawali CP, Bonavina L. Improving the Diagnostic Yield of High-Resolution Esophageal Manometry for GERD: The "Straight Leg-Raise" International Study. Clin Gastroenterol Hepatol. 2023 Jul;21(7):1761-1770.e1. doi: 10.1016/j.cgh.2022.10.008. Epub 2022 Oct 19.