Abstract
OBJECTIVE: Conclusive diagnosis of gastroesophageal reflux disease (GERD) can be challenging. When reflux monitoring is inconclusive, high-resolution esophageal manometry (HRM) may provide additional relevant information. We aimed to identify demographic and manometric parameters associated with GERD and to propose a diagnostic score. METHODS: Adult patients with GERD symptoms who underwent reflux monitoring and HRM were considered for inclusion. The gold standard for GERD diagnosis was acid exposure time (AET); patients with AET>6% and AET<4% were included. Univariate and multivariate analyses were performed. A diagnostic score was developed using parameters independently associated with GERD. Generation and validation cohorts were randomly selected in a 2:1 ratio. Diagnostic accuracy was assessed using the area under the receiver operating characteristic curve (AUC ROC). RESULTS: A total of 391 patients met the inclusion criteria; 167 had GERD (AET>6%) and 224 did not have GERD (AET<4%). In the multivariate analysis, age, male sex, and the distance between the lower esophageal sphincter and the crural diaphragm (LES-CD) were directly associated with GERD, while esophagogastric junction contractile integral (EGJ-CI) and distal contractile integral (DCI) were inversely associated with GERD (p values: 0.03, <0.01, <0.01, 0.01, and 0.01, respectively). The AUC ROC of a diagnostic score based on these parameters was 0.76 and 0.82 in the generation and validation cohorts, respectively. CONCLUSIONS: In this observational study, age, male sex, LES-CD distance, EGJ-CI, and DCI (AGES-D) were independently associated with GERD. A novel score incorporating these parameters could be useful in the assessment of inconclusive cases.