High Resolution Manometry to detect Transient Lower Esophageal Sphincter Relaxations: diagnostic accuracy compared to perfused-sleeve manometry and definition of new detection criteria.

International audienceBackground. Inhibition of transient lower esophageal sphincter relaxations (tLESRs) has become one of the most relevant therapeutic objective in patients with reflux symptoms resistant to proton pump inhibitors. TLESRs are currently detected by esophageal perfused-sleeve manometry (PSM), but esophageal high resolution manometry (HRM), which combines closely spaced pressure sensors and esophageal pressure topography plots, may prove to be a better tool. Aim. The aim of this study was to evaluate the efficacy, reproducibility and inter-observer agreement of HRM for the detection of tLESRs, in comparison with PSM. Methods: Twenty-four healthy volunteers underwent HRM alone and on a separate occasion with PSM simultaneously. LES pressure was monitored for 1 hour during fasting and 2 hours postprandial. Criteria for tLESRs were defined by characterizing spontaneous LES relaxation associated with common cavity, and then applied to all spontaneous LES relaxations. Inter observer agreement and the rates of tLESRs detected by HRM and PSM were compared. Results: New HRM criteria for the detection of tLESRs have been established. A similar number of tLESRs were identified during the 2 HRM recordings (median per subject 15 and 13 (p=0.07), and less with PSM (median per subject 11, p<0.01). The overall concordance rate between the 2 procedures was substantial (kappa=0.61). The inter-observer agreement was almost perfect (kappa=0.83) with HRM and only fair (kappa=0.38) with PSM. Conclusions: HRM is reproducible and more sensitive than PSM to detect tLESRs. HRM provides a better inter-observer agreement. These results confirm that HRM is the gold standard for detecting tLESRs

Controlling on-demand gastric acidity in obese subjects: a randomized, controlled trial comparing a single dose of 20 mg rabeprazole and 20 mg omeprazole.

International audienceBACKGROUND: Obesity is associated with a risk of gastroesophageal reflux disease. The pharmacodynamic efficacy of proton pump inhibitors has not been specifically evaluated in obese subjects. The aim of this study was to compare the antisecretory response to a single oral dose of 20 mg rabeprazole, 20 mg omeprazole and placebo in obese subjects. METHODS: Gastric pH was monitored for 24 hours on three separate occasions in eighteen H. pylori-negative, asymptomatic obese subjects. Subjects were given omeprazole, rabeprazole or placebo in a randomized order and in a double-blind fashion. The main analysis criterion was 24-h percent of time post dose with intragastric pH above 3; secondary criteria were percentage of time above pH 4, median pH, [H+] concentrations and nocturnal acid breakthrough (NAB). Results were analyzed using linear mixed models and Wilks test comparing variances. RESULTS: 24-h median [IQ] percentages of time with gastric pH above 3 and 4 were higher with rabeprazole than omeprazole (46 [37-55] vs. 30 [15-55] %, 9 [5-11] % for placebo) but the differences did not reach statistical significance (p = 0.11 and 0.24, respectively). Median acid concentrations were significantly lower with rabeprazole than with omeprazole and placebo (22 [14-53] vs. 54 [19-130] and 95 [73-170] mmoles/l, p < 0.01) for all periods. The number of NAB was significantly lower with rabeprazole than with omeprazole (median 1 [1,2] vs. 2 [1-3], p = 0.04). Variances of 24-h data (pH above 3 and 4, median pH, [H+] concentrations) were significantly lower with rabeprazole than with omeprazole (p < 0.0001). CONCLUSIONS: In asymptomatic obese subjects the gastric antisecretory response to a single dose of rabeprazole and omeprazole was strong and not significantly different between drugs despite a significantly more homogeneous response with rabeprazole. TRIAL REGISTRATION: ClinicalTrial.gov: NCT01136317