Atypical Manifestations of GORD, is it the oesophagus or not?
S Thomas1, L Barry1, D Houlihan1’2, L Jackson1,2 & W Stack1,2
Department of Gastroenterology & Gastro-intestinal Physiology1, Bon Secours Hospital, Cork and School of Medicine, University College Cork2.
The Lyon Consensus 2018 describes mean nocturnal baseline impedance (MNBI) as a reflection of oesophageal mucosal permeability, with lower values found in erosive reflux disease than non-erosive reflux disease (NERD). Its role in patients with specific atypical symptoms attributed to reflux remains to be determined.
To assess the relationship between MNBI, Acid Exposure Time (AET) & DeMeester Score in our patient population, focusing on suspected extra-oesophageal manifestations of GORD
We reviewed High Resolution Impedance manometry and 24-hour ambulatory pH and impedance studies of 309 (127M, 179F) consecutive patients from February ’21 to February ‘22.
197/306 (64.37%) patients had typical symptoms of GORD 109 of 306 (35.6%) presented with atypical symptoms of GORD. 35/306(14M, 21F) (11.4%) had non-cardiac chest pain, 34/306(13M, 21F) (11.11%) had chronic cough and 40/306(14M, 26F) (13.07%) had pharyngeal discomfort. 51(35.02%) GORD had abnormal AET (>4.2%), 69 had elevated DeMeester (>14.72) & 139 (70.5%) had elevated MNBI (>2292 ohms) Chest pain; abnormal AET was found in 3 (8.5%), 4 (11.42%) abnormal DeMeester & 19 (54.2%) had elevated MNBI. Chronic Cough; abnormal AET & DeMeester was found in 5 (14.7%) patients. 22 (64.7%) had elevated MNBI. Pharyngeal discomfort; abnormal AET & DeMeester was found in 3 (7.5%) patients. 19 (47.5%) patients had elevated MNBI
Abnormal MNBI was a common finding in those with atypical symptoms of GORD compared to other conventional measurements used in pH/Z monitoring such as AET and DeMeester score indicating a possible non-acid aetiology in these conditions.