Manometric Parameters of Esophagogastric Junction Competence: A Systematic Literature Review

Background: Although endoscopy and pH monitoring are gold standards for diagnosing gastroesophageal reflux disease (GERD), manometry provides additional insights into esophagogastric junction (EGJ) morphophysiology. This systematic review aims to summarize the diagnostic performance of manometric parameters that have been explored as GERD predictors. Methods: A systematic search of MEDLINE, Embase, and EBSCO (1970-2024) identified studies comparing manometric metrics in adults (≥ 18-years-old) with or without GERD using pH monitoring or Lyon criteria as reference standards. Manometry metrics were compared between groups, diagnostic performance was synthesized, and risk of bias was assessed. Key results: We found 59 eligible studies (50 cross-sectional, nine cohort; 10,672 patients). Thresholds for competent lower esophageal sphincter (LES) included overall length < 2 to 3 cm (sensitivity [SE] 2.6%-64%, specificity [SP] 81.5%-98.9%) and abdominal length < 1 cm (SE 4.5%-70%, SP 45%-98.4%). Parameters that differed significantly between GERD and non-GERD groups included: LES pressure in 16/40 studies, EGJ contractile integral (EGJ-CI) in 14/17 studies, and LES pressure integral (LESPI) in 3/4 studies. EGJ morphology differed between the groups using the 2017 Consensus in 6/7 studies and using Akimoto classification in 1/1 study. Transabdominal pressure gradient was significantly different between groups in 5/5 studies. Among novel metrics, total EGJ-CI (SE 81%, SP 52%) and the straight leg raise maneuver (SE 71%-79%, SP 75%-85%) performed best. Conclusions and inferences: Although none of the manometric EGJ metrics reliably predict GERD, some of them show potential in assessing EGJ competence, which could guide treatment as endoscopic and surgical options for restoring competence expand.