Retrospective Evaluation of pH-Impedance, Manometry, and Endoscopy Patients with Hypersensitive Esophagus and Its Treatment Outcomes

Authors : Ayça Eroğlu Haktanır, Altay Çelebi

Pages : 547-557

Doi:10.32708/uutfd.1801103

View : 37 | Download : 277

Publication Date : 2025-12-08

Article Type : Research Paper

Abstract :Hypersensitive esophagus (HE) is a clinical entity characterized by typical reflux symptoms despite normal acid exposure time (AET) on pH-impedance monitoring. Understanding its pathophysiology and optimizing management remain challenging. This retrospective study evaluated clinical characteristics, endoscopic and functional findings, symptom-reflux association, and treatment outcomes in 142 patients who met the Lyon Consensus 2.0 criteria for HE (AET <4%, symptom index [SI] and/or symptom association probability [SAP] positive). Endoscopic findings were classified according to the Los Angeles classification, and high-resolution manometry results were interpreted based on the Chicago Classification v4.0. SI and SAP. values were calculated. The cohort was predominantly female (70.4%) with a mean age of 42.2 ± 11.8 years. Heartburn (83.1%) and regurgitation (76.1%) were the most frequent. Endoscopy was normal in most, with only 7.0% showing mild esophagitis. Mean AET was 1.56% ± 0.99%. No significant differences were found in reflux burden, motility, or baseline impedance between symptom-based subgroups. SI positivity was linked to increased reflux time and diminished lower esophageal sphincter tone; SAP positivity correlated with reduced distal contractile integral. Overall treatment response was 37.3%, while second-line therapies—particularly selective serotonin reuptake inhibitors (SSRIs)—achieved a high success rate of 98.9% among the 89 patients who did not respond to initial treatment. HE is a distinct disorder with minimal acid burden and functional alterations, poorly captured by conventional metrics. Symptom association indices may aid diagnosis but cannot guide treatment alone. Neuromodulatory approaches, particularly SSRIs, appear more effective than acid suppression, highlighting the importance of individualized, perception-targeted strategies.
Keywords : Hipersensitif özofagus, pH-impedans izleme, özofagus motilitesi, yüksek çözünürlüklü özofagus manometrisi, bazal mukoza empedansı, semptom ilişki olasılığı

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