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Prolonged measurement of lower oesophageal sphincter function in patients with intestinal metaplasia at the oesophagogastric junction

BACKGROUND AND AIMS It has been shown that gastro-oesophageal reflux plays a role in the pathogenesis of intestinal metaplasia (IM) limited to the oesophagogastric junction (OGJ), similar to the pathogenesis of IM in long segments of columnar lined oesophagus. The aim of this study was to examine lower oesophageal sphincter (LOS) function by means of prolonged recording in patients with IM limited to a normal appearing OGJ. PATIENTS AND METHODS Eighteen patients with IM at the OGJ (five females, 13 males; mean age 55.4 years) and 22 patients without IM (nine females, 13 males; mean age 53.9 years) underwent conventional stationary oesophageal manometry. Thereafter, seven hour water perfused manometry with simultaneous pH measurement (probe 5 cm proximal to the LOS) was performed. Swallowing was monitored with a pharyngeal sidehole and LOS pressure was recorded with a Dent sleeve. Patients were studied in the fasted state (three hours) and after a standardised meal (four hours). LOS pressure was analysed using customised software, and the incidence of reflux episodes (pH <4 for at least five seconds) and transient LOS relaxations (TLOSRs) were examined. TLOSRs were judged to be accompanied by reflux if a decrease of 1 pH unit occurred during relaxation. RESULTS Patients with IM at the OGJ had a higher prevalence of postprandial acid reflux compared with patients without IM. No differences were observed in LOS pressure (pre- and postprandially) or in the prevalence of TLOSRs. However, in the postprandial phase, the rate of TLOSRs accompanied by acid reflux was increased in patients with IM. CONCLUSION Patients with IM at the OGJ have a higher prevalence of postprandial acid reflux. This is not associated with a higher prevalence of TLOSRs or a decreased LOS pressure but with a higher rate of TLOSRs accompanied by reflux.