{
  "abstract": "Background Gastroesophageal reflux disease (GERD) encompasses a spectrum of structural and functional abnormalities that often elude single-modality diagnosis. While esophagoscopy and radiologic imaging remain foundational in evaluating mucosal and anatomical changes, high-resolution esophageal manometry (HREM) offers unparalleled insight into esophageal motor function. This study aimed to assess the diagnostic concordance among these three modalities and identify clinical predictors of esophageal motility disorders in a large Saudi cohort.Methods Data of 317 adult patients were analyzed retrospectively (mean age 43.2 ± 13.9 years; 61.5% female) with clinically suspected GERD who underwent esophagoscopy, imaging (barium or gastrograffin swallow), and HREM. Manometric diagnoses were classified using the Chicago Classification v4.0. Concordance between modalities was evaluated using Cohen’s kappa coefficient. Univariate and multivariate logistic regression analyses were performed to identify predictors of abnormal motility.Results Structural abnormalities were identified in 44.5% of patients via imaging and in 41.3% via esophagoscopy, with hiatal hernia (32.8%) and esophagitis (29.7%) being the most common findings. HREM revealed motility disorders in 62.1% of patients, with ineffective esophageal motility (IEM) being the most prevalent (38.2%), followed by EGJ outflow obstruction (7.6%), absent contractility (6.3%), and achalasia subtypes (5.7%). Among patients with normal imaging, 35.4% had abnormal HREM findings, while 22.1% of those with structural lesions exhibited normal motility. Diagnostic overlap between imaging and esophagoscopy was moderate (κ = 0.49), whereas overlap between structural modalities and HREM was limited (κ = 0.28), underscoring the functional diagnostic gap.Multivariate analysis identified age > 50 years (OR 1.9; 95% CI 1.2–3.1; p = 0.006), presence of esophagitis (OR 2.3; 95% CI 1.4–3.8; p = 0.001), and prior upper GI surgery (OR 2.7; 95% CI 1.5–4.9; p = 0.002) as independent predictors of abnormal motility. PPI use was not significantly associated with HREM outcomes (p = 0.18).Conclusions This tri-modality evaluation highlights the complementary roles of esophagoscopy, imaging, and HREM in GERD assessment. While structural tools are essential for identifying mucosal and anatomical changes, HREM provides indispensable functional insights, particularly in patients with refractory symptoms or inconclusive imaging. A multimodal diagnostic approach should be considered standard practice in the comprehensive evaluation of GERD.",
  "authors": [
    {
      "affiliations": [
        "King Abdullah Medical City, Makkah, Saudi Arabia"
      ],
      "name": "Laeeque A Qureshi"
    },
    {
      "affiliations": [
        "King Abdullah Medical City, Makkah, Saudi Arabia"
      ],
      "name": "Salem Alotaibi"
    },
    {
      "affiliations": [
        "King Abdullah Medical City, Makkah, Saudi Arabia"
      ],
      "name": "Mohammed S Khan"
    },
    {
      "affiliations": [
        "King Abdullah Medical City, Makkah, Saudi Arabia"
      ],
      "name": "Adnan Alzanbagi"
    },
    {
      "affiliations": [
        "King Abdullah Medical City, Makkah, Saudi Arabia"
      ],
      "name": "Abdulaziz Tashkandi"
    },
    {
      "affiliations": [
        "King Abdullah Medical City, Makkah, Saudi Arabia"
      ],
      "name": "Mona Alsaedi"
    },
    {
      "affiliations": [
        "King Abdullah Medical City, Makkah, Saudi Arabia"
      ],
      "name": "Yasser K Meeralam"
    },
    {
      "affiliations": [
        "King Abdullah Medical City, Makkah, Saudi Arabia"
      ],
      "name": "Mohammed K Shariff"
    }
  ],
  "title": "IDDF2026-ABS-0470 Multimodal diagnostic concordance in gastroesophageal reflux disease: comparative evaluation of esophagoscopy, radiologic imaging, and high-resolution esophageal manometry",
  "uid": "4018b4ee-1f21-522a-aa19-653873d65dd5"
}