Manometric Parameters of Esophagogastric Junction Competence Are Equivalent Predictors of Gastroesophageal Reflux Disease: A Head‐To‐Head Comparison
Carlo Galdino Riva, Stefano Siboni, Jiurgen Mema, Roberta De Maron, Marco Sozzi, Emanuele AstiABSTRACT
Background
Several high‐resolution manometry (HRM) metrics of esophagogastric junction (EGJ) competence exist, but they have never been compared head‐to‐head in one cohort against a uniform gastroesophageal reflux disease (GERD) definition. We aimed to assess whether any anatomical or pressure metric outperforms the others.
Methods
Consecutive patients undergoing endoscopy, HRM, and ambulatory reflux monitoring for suspected GERD between December 2022 and December 2025 were studied. GERD was defined by the Lyon 2.0 criteria. All EGJ metrics were recalculated de novo by a single blinded reader. Paired AUC differences were tested with the DeLong method and interpreted against a pre‐specified equivalence margin of ΔAUC 0.05.
Results
Of 429 patients (48.3% male; median age 52 years), 212 (49.4%) had GERD. Every metric differed between groups (all p < 0.001) and correlated weakly to moderately with acid exposure time and mean nocturnal baseline impedance. Among anatomical metrics, EGJ morphology (2017 Consensus) had the highest AUC (0.714); LES intra‐abdominal length, hiatal hernia, and Akimoto morphology were equivalent (95% CI of ΔAUC within ±0.05), whereas LES total length performed worse (ΔAUC 0.095, 95% CI 0.034–0.155). Among pressure metrics, EGJ‐CI at IGP + 2 mmHg had the highest AUC (0.692), and six of seven comparators were equivalent. Comparisons between hiatal hernia sizing methods and for LESPI were inconclusive.
Conclusions
Anatomical and pressure HRM metrics of EGJ competence are equivalent within a 0.05 AUC margin and all provide only moderate discrimination for GERD. None can be preferred on diagnostic grounds, so the simplest and fastest to calculate may reasonably be chosen.