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POSITIONING IN HIGH RESOLUTION MANOMETRY IN PATIENTS WITH GASTRO-ESOPHAGEAL REFLUX DISEASE. DOES IT MATTER?

Theodoros Voulgaris 1, Reuma Yehuda Margalit 1, Shintaro Hoshino 1, Shirley Sonmez 1, Etsuro Yazaki 1

Affiliations

1 Barts and The London School of Medicine and Dentistry, Royal London Hospital, Wingate Institute of Neurogastroenterology, Blizard Institute, Queen Mary University of London, London, United Kingdom

Summary

AI Generated

In 49 patients with GERD, upright high-resolution manometry doubled the diagnosis rate of ineffective esophageal motility compared to supine position, but upright diagnosis correlated less with inadequate multiple rapid swallow response and showed no correlation with dysphagia symptoms.

Mean distal contractile integral was significantly lower in upright (1629 mm²/s/mmHg) versus supine position (2762 mm²/s/mmHg, p=0.010), with upright position showing significantly higher rates of ineffective swallows (29.0% vs 12.3%, p=0.010).
Ineffective esophageal motility or absent contractility was diagnosed in 16.3% of patients in upright position versus 8.2% in supine position (p=0.001).
Inadequate post-multiple rapid swallow contraction occurred in 75% of patients with supine-position diagnosis versus 50% with upright-position diagnosis, and dysphagia showed no correlation with ineffective motility diagnosis in either position.
The authors suggest that upright testing may lead to overdiagnosis in GERD patients and propose that manometry in this population may be better performed only in the supine position.

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Abstract

Introduction

According to guidelines, in order to strictly diagnose esophageal motility disorders, besides achalasia, high resolution manometry (HRM) findings should be documented in both the upright and the supine position. A common finding among patients with Gastro-Esophageal Reflux Disease GERD submitted to manometry is ineffective esophageal motility (IEM). The clinical impact of such a diagnosis in this setting is ambiguous though it may denote future disturbance of peristaltic reserve even if until now only inadequate response to multiple rapid swallows (MRS) has been correlated to post anti-reflux surgery dysphagia.

Aims & Methods

We aimed to evaluate differences in esophageal contractility in different positions in patients with definite GERD.We included consecutive patients with definite GERD according to Acid Exposure Time (>6%) submitted simultaneously to 24 hours pH impedance off PPI study and HRM in both the upright and supine position. Patients with previous esophago-gastric surgeries as also patients diagnosed with motility disorders besides IEM/absent contractility according to Chicago 4 guidelines were excluded.

Results

In total 49 patients (M/F:26 (53.1%)/23 (46.9%), mean age:51±14) were included. The main referral reason was typical reflux symptoms in 37/49 (75.5%) patients while 8/49 (16.3%) reported dysphagia. Mean Distal Contractile Integral (DCI) was significantly reduced in the upright position (1629.2±1175.6 mm²/s/mmHg) vs supine position (2762.4±2710.4 mm²/s/mmHg), p=0.010. The rate of total ineffective swallows in the upright position was significantly increased in the upright position (29.0%) vs the supine (12.3%), p=0.010 as was also the rate of weak contraction (10.3% vs 3.1%, p=0.033 ) and marginally not of absent contractions (17.0% vs 8.3%, p=0.078). The rate of diagnosis of IEM/absent contractility was doubled in the upright position (8/49, 16.3%) vs in the supine position (4/49, 8.2%) (k-value:0.473, p=0.001). Inadequate post MRS contraction was observed in 9/49 (18.4%) and more specifically among 3/4 (75%) patients with IEM/absent contractility diagnosis in the supine position (k:-0.436, p=0.002) vs 4/8 (50%) in the upright position (k:-0.361, p=0.011). Dysphagia was not correlated to diagnosis of IEM/absent contractility neither in the supine (p=0.675) nor the upright position (p=0.586).

Conclusion

Upright position in HRM is correlated to a decreased mean DCI and an increased rate of ineffective esophageal contractions leading to an increased rate of diagnosis of IEM/absent contractility. Such a diagnosis in the upright position is correlated in a lesser extent to inadequate post-MRS swallow and not correlated to symptom of dysphagia. Until new data arise such an overdiagnosis among patients with GERD may be misleading and therefore the procedure in such patient may be better to be undertaken only in the supine position.

Conference

UEG Week Copenhagen 2023

Topics

Oesophagus

Submission format

Abstract

Session

PP 01 Oesophageal, gastric and duodenal disorders (Posters)

Citation

United European Gastroenterology Journal 2023; 11 (Supplement 8)

Published

2023

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Maura Corsetti, Pradeep Mundre

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Abstract

Topics

Neurogastroenterology & Motility

Published

2026

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Persistent or relapsing symptoms in treated coeliac disease

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Persistent or relapsing symptoms in treated coeliac disease

Julio Bai 1

Affiliations

1 Hospital de Gastroenterología Dr. C. Bonorino Udaondo, Buenos Aires, Argentina

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Abstract

Event

UEG Week Barcelona 2026

Session

Hot topics from Pan-America

Citation

2026: United European Gastroenterology Journal 2026; 14 (S1)

Published

2026

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MAJOR ADVERSE CARDIOVASCULAR EVENTS DURING PREGNANCY AND POSTPARTUM IN WOMEN WITH INFLAMMATORY BOWEL DISEASE: A POPULATION-BASED COHORT AND CASE-CONTROL STUDY

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MAJOR ADVERSE CARDIOVASCULAR EVENTS DURING PREGNANCY AND POSTPARTUM IN WOMEN WITH INFLAMMATORY BOWEL DISEASE: A POPULATION-BASED COHORT AND CASE-CONTROL STUDY

Julian Heierle 1, Christian Eichhorn 1, Carole Marxer 2, Alexander Kutz 3,4, Flurina Gass 1, Jan Hendrik Niess 1,4, Petr Hruz 1, Anders Forss 2, Fahim Ebrahimi 1,2

Affiliations

1 University Hospital Basel, Basel, Switzerland

2 Karolinska Institutet, Stockholm, Sweden

3 Kantonsspital Aarau, Aarau, Switzerland

4 University of Basel, Basel, Switzerland

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Abstract

Introduction

Inflammatory bowel disease (IBD) commonly affects women of reproductive age. Although both pregnancy and IBD have been associated with an increased risk of major adverse cardiovascular events (MACE), the risk of MACE during pregnancy and after delivery among women with IBD is not well characterized.

Aims & Methods

We conducted a population-based cohort and case-control study including all women with a delivery resulting in live birth in Switzerland between 2012 and 2022. Women with and without IBD were followed from discharge after delivery hospitalization to assess the risk of MACE, defined as a composite of acute myocardial infarction, stroke, hospitalization for heart failure, or all-cause mortality. Follow-up was divided into a postpartum period (≤3 months) and long-term follow-up. Women were censored at the time of a subsequent pregnancy, an outcome event, or the end of the study period. Weighted hazard ratios (HR) were estimated using Cox regression. To study the MACE risk during pregnancy (divided into pregnancy period [defined as 10 months prior to delivery hospitalization excluding delivery hospitalization] and delivery hospitalization), we conducted a case-control study and estimated odds ratios (OR) using weighted logistic regression. In both analyses, stabilized inverse probability of treatment weighting (IPTW) was used to balance baseline covariates.

Results

Among 658,776 women with a delivery resulting in live birth, 1,831 had IBD (Crohn's disease, n=1,021; ulcerative colitis, n=810). During a median follow-up of 3.4 years, MACE occurred in 9 women with IBD (incidence rate [IR], 8.7 per 100,000 person-years) and 1,398 women without IBD (IR, 3.9 per 100,000 person-years), yielding a weighted HR of 2.21 (95% confidence interval [CI], 1.05-4.64). This association was primarily driven by stroke (HR, 3.06; 95% CI, 1.02-9.16), whereas no significant associations were observed for the other MACE components. Most events occurred beyond 3 months after delivery in both groups (women with IBD: 89%; women without IBD: 84%). No significant differences were observed according to IBD subtype or other predefined subgroups (age, multiple gestation, prior MACE, prior VTE). In the case-control analysis, IBD was not associated with increased MACE risk during pregnancy (odds ratio [OR], 0.73; 95% CI, 0.10-5.26) or at delivery hospitalization (OR, 1.62; 95% CI, 0.30-8.73).

Period	Events in Women with IBD	Events in Women without IBD	HR / OR	P-value
Period	N (%)	N (%)	(95% CI)	P-value
Pregnancy	1 (0.05)	88 (0.01)	0.73 (0.10-5.26)	0.76
Delivery Hospitalization	2 (0.11)	235 (0.04)	1.62 (0.30-8.73)	0.58
Postpartum Period	1 (0.05)	226 (0.03)	0.29 (0.04-2.03)	0.21
Long-term Follow-Up	9 (0.49)	1,398 (0.21)	2.21 (1.05-4.64)	0.04

Table 1: MACE risk across pregnancy and postpartum periods in women with and without IBD.
^{IPTW-adjusted. Pregnancy and delivery hospitalization: OR (weighted logistic regression); postpartum period and long-term follow-up: HR (weighted Cox regression).}

Conclusion

Among women with a delivery resulting in live birth, IBD was not associated with an increased MACE risk during pregnancy or the postpartum period. However, women with IBD had a more than twofold higher long-term risk of MACE after delivery, primarily driven by stroke. These findings support consideration of long-term cardiovascular risk assessment in women with IBD after pregnancy.

Event

UEG Week Barcelona 2026

Topics

IBD

Submission format

Abstract

Session

Lessons from large IBD real-world cohorts

Citation

2026: United European Gastroenterology Journal 2026; 14 (S1)

Published

2026

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Consensus

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Esophageal and Oropharyngeal Dysphagia: Clinical Recommendations From the United European Gastroenterology and European Society for Neurogastroenterology and Motility

Amir Mari

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Guideline

ABSTRACT

Dysphagia is a prevalent symptom of the upper gastrointestinal tract causing health related consequences, impacting quality of life and is associated with global economic burden. Swallowing difficulties are classified into oropharyngeal dysphagia (OD) and esophageal dysphagia. Despite its clinical importance, dysphagia is associated with several uncertainties regarding its optimal diagnostic work-up and management, particularly, considering the progress with diagnostic modalities and technologies. A Delphi consensus was performed with experts from various disciplines who conducted a literature summary and voting process on 41 statements. Quality of evidence was evaluated using the grading of recommendations, assessment, development, and evaluation criteria. Consensus was reached for all the statements. The panel agreed with the definition and prevalence of esophageal and OD types. The role of endoscopy, high-resolution manometry, EndoFLIP, barium swallow and other imaging tests in evaluating esophageal dysphagia has reached overall strong agreement. Videofluoroscopic swallow study, alongside fiber-endoscopic evaluation of swallowing, as the methods of choice for the instrumental assessment of oropharyngeal dysfunction is a strong recommendation. Regarding treatment, a weak recommendation was achieved for the use of PPIs, calcium-channel blockers, nitrates, phosphodiesterase type 5 inhibitors, antidepressants or peppermint oil for the treatment of hypercontractile esophagus. A strong recommendation exists for endoscopic and surgical treatment of achalasia, while a weak recommendation is provided for other esophageal motility disorders. Regarding OD, a weak recommendation was achieved for swallow therapy, to improve swallowing mechanics, reduce symptoms, and enhance quality of life. Swallow therapy could be more effective when using validated assessment tools, consistent treatment parameters, and considering long-term follow-up. A multinational group of European experts summarized the current state of consensus on the definition, diagnosis, and management of dysphagia.

Publisher

European Society of Neurogastroenterology and Motility

Guideline

Consensus

Topics

Neurogastroenterology & Motility Oesophagus

Citation

United European Gastroenterol J, 13: 855-901

Published

2025

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Clinical management of PSC/IBD

Johannes Hov 1

Affiliations

1 Oslo University Hospital Rikshospitalet - Norwegian PSC Research Center, Oslo University Hospital Ri, Oslo, Norway

Summary

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Abstract

Event

UEG Week Barcelona 2026

Topics

Mechanisms & Personalised Medicine Surgery IBD Hepatobiliary

Session

How to tackle PSC/IBD from a multidisciplinary perspective

Citation

2026: United European Gastroenterology Journal 2026; 14 (S1)

Published

2026

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Targeted therapies beyond immunotherapy

Michael Quante 1

Affiliations

1 Medizinische Klinik II, Muniche, Germany

Summary

AI Generated

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Abstract

Event

UEG Week Barcelona 2026

Topics

Digestive Oncology Surgery Stomach & H. Pylori Oesophagus Endoscopy

Session

Therapy update: Advanced therapy of gastro-oesophageal cancer

Citation

2026: United European Gastroenterology Journal 2026; 14 (S1)

Published

2026

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