The integrated relaxation pressure may not be an appropriate gold standard for deglutitive relaxation due to reliance on a single intragastric reference sensor. Neurogastroenterology and motility : the official journal of the European Gastrointestinal Motility Society Fass, O. Z., Regalia, K. A., Sweatt, A. J., Nandwani, M. C., Zikos, T. A., Fernandez-Becker, N. Q., Nguyen, L. A., Sonu, I. S., Triadafilopoulos, G., Clarke, J. O. 2023: e14635


BACKGROUND: Integrated relaxation pressure (IRP) calculation depends on the selection of a single gastric reference sensor. Variable gastric pressure readings due to sensor selection can lead to diagnostic uncertainty. This study aimed to examine the effect of gastric reference sensor selection on IRP measurement and diagnosis.METHODS: We identified high-resolution manometry (HRM) conducted between January and November 2017 with at least six intragastric reference sensors. IRP measurements and Chicago Classification 3.0 (CCv3) diagnoses were obtained for each of six gastric reference sensors. Studies were categorized as "stable" (no change in diagnosis) or "variable" (change in diagnosis with gastric reference selection). Variable diagnoses were further divided into "variable normal/dysmotility" (=1 normal IRP measurement and=1 CCv3 diagnosis), or "variable dysmotility" (=1 CCv3 diagnosis, only elevated IRP measurements). Bland-Altman plots were used to compare IRP measurements within HRM studies.KEY RESULTS: The analysis included 100 HRM studies, among which 18% had variable normal/dysmotility, and 10% had variable dysmotility. The average IRP difference between reference sensors was 6.7mmHg for variable normal/dysmotility and 5.9mmHg for variable dysmotility. The average difference between the proximal-most and distal-most sensors was -1.52mmHg (lower limit of agreement -10.03mmHg, upper limit of agreement 7.00mmHg).CONCLUSIONS & INFERENCES: IRP values can vary greatly depending on the reference sensor used, leading to inconsistent diagnoses in 28% of HRM studies. Choosing the correct gastric reference sensor is crucial for accurate test results and avoiding misdiagnosis. Standardization of reference sensor selection or supportive testing for uncertain results should be considered.

View details for DOI 10.1111/nmo.14635

View details for PubMedID 37357376