Table 2.
EGJ Metrics of Barrier Integrity: Accepted Statements
| HRM Metrics for EGJ Barrier Integrity | |||
|---|---|---|---|
| Recommended Statement | Percent Agreement | Strength of Recommendation | Level of Evidence* |
| The EGJ complex should be measured during quiet respiration in the baseline recording in a segment relatively devoid of swallowing and/or recording artifacts. This also refers to measurement of intragastric pressure, which should be measured below the CD over three complete respiratory cycles, preferably in the same segment as used to measure the EGJ-CI | 95% | Strong | |
| LES-CD separation should be scored as the distance between the center of the CD and LES signal during inspiration, unless obscured in which case the LES position should be scored at expiration | 91% | Strong | |
| The RIP is the axial location at which the inspiratory change in pressure transitions from an inspiratory increase, characteristic of intra-abdominal recordings, to an inspiratory decrease, characteristic of intrathoracic recordings | 95% | Strong | Very Low |
There can be 3 subtypes of EGJ pressure topography
|
80% | Conditional | Low |
| In the normal state (EGJ subtype 1) the RIP localizes at the proximal margin of the LES-CD (EGJ) complex. | 88% | Strong | Low |
| With hiatus hernia the RIP can localize either between the LES and CD or proximal to the LES | 81% | Conditional | Low |
| With an LES-CD >3 cm, the RIP location and relation to LES can be unreliable. However, these patients usually have an incompetent EGJ. | 81% | Conditional | Low |
| The EGJ-CI should be referenced to intragastric pressure and expressed in units of mmHg•cm | 86% | Strong | |
| Intragastric pressure should be measured during quiet respiration in the baseline recording in a segment relatively devoid of swallowing and/or recording artifacts, preferably the same segment as used to measure the EGJ-CI. | 95% | Strong | |
*
GRADE process performed when applicable