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Background: Postreflux swallow‐induced peristaltic wave (PSPW) on pH‐impedance monitoring and contraction vigor on high‐resolution manometry (HRM) both assess esophageal peristaltic response. We aimed to evaluate relationships between PSPW and esophageal peristalsis on HRM in the context of reflux disease in this multicenter cohort study. Methods: pH‐impedance and HRM studies performed on patients with persisting reflux symptoms were reviewed from 6 centers (5 in Europe and 1 in US). Total, upright and supine acid exposure time (AET) were evaluated from pH‐impedance studies; PSPW index (PSPWI) and mean nocturnal baseline impedance (MNBI) were calculated using standard methodology. Esophageal body contraction vigor was analyzed using distal contractile integral (DCI), and DCI ratio > 1 between single swallows and multiple rapid swallows (MRS) defined presence of contraction reserve. Student's t test, ANOVA, and linear regression were utilized to investigate relationships between PSPW, contraction vigor, and contraction reserve. Key Results: Of 296 patients (52.8 ± 0.8 yr, 63% F), median PSPWI was 0.475. Only 24.0% had intact DCI; the remainder had varying degrees of hypomotility. As hypomotility increased, PSPWI and MNBI decreased significantly, while total AET and reflux episodes had an inverse response (P ≤.002 for each). MRS data were available in 167 (56.4%), 72.5% had contraction reserve. MRS cohorts with normal PSPWI had significantly lower reflux burden compared to low PSPWI, regardless of presence or absence of contraction reserve (P ≤.001). Conclusions and Inferences: PSPWI correlates with esophageal hypomotility and reflux burden, and complements clinical reflux evaluation. Intact PSPW is more relevant to esophageal reflux clearance than contraction reserve. [ABSTRACT FROM AUTHOR]

Background: Esophageal high-resolution manometry (HRM) allows accurate evaluation of esophageal motility. Normal values for HRM were established in the United States and several new parameters were introduced since. We aimed to provide a complete set of normal values for HRM obtained in a European population, including all current metrics used to describe the function of the upper esophageal sphincter (UES), the esophageal body, and the esophagogastric junction (EGJ)., Methods: Fifty healthy volunteers underwent esophageal HRM. Subjects swallowed 10 liquid boluses in supine position, after which UES, EGJ, and contraction wave parameters were evaluated. Mean and median values with 5-95th percentile ranges were calculated., Key Results: The normative thresholds (5-95th percentile) for the various parameters were; UES resting pressure 34.6-137.7 mmHg, UES residual pressure 0.0-8.5 mmHg, UES 0.2-s integrated relaxation pressure (IRP) 0.0-14.5 mmHg, EGJ length 3.1-6.3 cm, EGJ resting pressure 3.0-31.2 mmHg, EGJ 4-s IRP 2.0-15.5 mmHg, intrabolus pressure (IBP) 6.6-19.5 mmHg, distal contractile integral 178-2828 mmHg*s*cm, contractile front velocity (CFV) 2.9-5.9 cm s(-1) , distal latency 5.4-8.5 s, and transition zone length 0.0-8.2 cm., Conclusions & Inferences: Most HRM parameters assessed in this study resemble the previously described values on which the current criteria are based, supporting the widespread use of these criteria for clinical purposes. However, vigor of the esophageal contraction was lower and transition zone length larger than in previous reports. Peristaltic breaks occur frequently in healthy subjects., (© 2014 John Wiley & Sons Ltd.)