Diagnostic of Transient Lower Esophageal Sphincter Relaxation With Combined Impedance and High Resolution Manometry in Patients With GERD

Diagnostic of Transient Lower Esophageal Sphincter Relaxation With Combined Impedance and High Resolution Manometry in Patients With GERD.

The aim of this study is to establish and validate High resolution manometry (HRM) criteria for the definition of transient lower esophageal sphincter relaxations (tLESRs) in gastroesophageal reflux disease (GERD) patients.

tLESRs represent the main mechanism of all types of reflux events. Inhibition of transient lower esophageal sphincter relaxations (tLESRs) has become one of the most relevant therapeutic objectives in patients with reflux symptoms resistant to proton pump inhibitors. HRM is the gold standard for detecting and characterizing tLESR, and could be considered as part of the pharmacological evaluation of new drugs targeting tLESRs. HRM criteria for the objective definition of tLESRs in GERD patients have to be established, as it has been done in healthy patients Subjects will undergo impedance / manometry recording with solid-state catheter systems, during a 30-min fasting and a 2-hour postprandial periods.

Inclusion Criteria:

• Patients 18 to 75 years old

• GERD documented by :

  • Typical reflux symptoms (heartburn, regurgitations) completely responsive to PPI therapy
  • And/or erosive esophagitis or Barrett's esophagus at endoscopy
  • And/or positive pH 24h monitoring (acid exposure time > 5% or positive symptom association indices)

• Possibility of easily positioned transnasal catheter

• Patients covered by social security

• Subjects must provide written, free and informed consent

Exclusion Criteria:

• Pregnant or lactating women
• History of digestive or thoracic surgery (except appendicectomy)
• Patients unable to stop PPI therapy for 7 days
• Subjects unable to provide written consent, including adult under guardianship and emergency situation
• Simultaneous participation in another study