Correlation study between upper/lower esophageal sphincter pressure and gastroesophageal reflux disease with or without esophageal mucosal injury

doi:10.3877/cma.j.issn.1674-392X.2019.01.009

Abstract

Abstract:

Objective

To study esophageal motility differences with or without esophageal mucosa injury in gastroesophageal reflux disease (GERD).

Methods

A retrospective analysis of patients with symptoms such as acid reflux, heartburn, chest pain and other symptoms was performed in the PLA General Hospital from January 2015 to December 2017. The 24-hour esophageal pH monitoring had a Demeester score ≥14.72 points. The erosive esophagus was classified according to endoscopic findings. In the erosive reflux disease (ERD) group and non-erosive reflux disease (NERD) group, changes in esophageal kinetic parameters were compared between the two groups.

Results

The average value of UESP in NERD group and ERD group was similar, with no significant difference (P=0.168). The UESRP, LESP, LESP, LESRP, LESRP and DCI were higher in NERD group than those in ERD group (P<0.001). The average age of NERD group was significantly lower than ERD group (P<0.000 1), with statistical significance. The height of NERD group was lower than ERD group, and the body weight and the BMI were both smaller in NERD group. The data of three groups were statistically significant.

Conclusion

With age growing and BMI increasing, the severity of GERD may be worse. In addition, the upper and lower esophageal sphincter dysfunction in patients with ERD are more critical than NERD.

Key words: Gastroesophageal reflux disease, Upper esophageal sphincter, Lower esophageal sphincter, High-resolution esophageal manometry

Jian Wang, Yichao Shi, Huijun Zhao, Xiaoxiao Wang, Lihua Peng, Yunsheng Yang. Correlation study between upper/lower esophageal sphincter pressure and gastroesophageal reflux disease with or without esophageal mucosal injury[J]. Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition), 2019, 13(01): 32-35.

/ / Recommend

Add to citation manager EndNote|Ris|BibTeX

URL: https://zhshfbwkzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1674-392X.2019.01.009

https://zhshfbwkzz.cma-cmc.com.cn/EN/Y2019/V13/I01/32

Figures/Tables 2

References 28

[1]	Fock KM, et al. Asia-Pacific consensus on the management of gastro-oesophageal reflux disease: an update focusing on refractory reflux diseaseand Barrett's oesophagus[J]. Gut 2016, 65(9): 1402-1415.
[2]	Eggleston A, Katelaris PH, Nandurkar S, et al. Clinical trial: the treatment of gastro-oesophageal reflux disease inprimary care-prospective randomized comparison of rabeprazole 20 mg with esomeprazole 20 and 40 mg[J]. Aliment Pharmacol Ther, 2009, 29(9): 967-978.
[3]	Dent J, El-Serag HB, Wallander MA, et al. Epidemiology of gastro-oesophageal reflux disease: a systematic review[J]. Gut, 2015, 54(5): 710-717.
[4]	史燕妹, 赵公芳, 黄华胃. 食管反流病的发病机制及其诊治的进展[J]. 世界华人消化杂志, 2012, 20(35): 3713-3718.
[5]	孙晓红, 柯美云, 王智凤, 等. 非糜烂性胃食管反流病和反流性食管炎的食管动力特点[J]. 中华医学杂志, 2014, 94(22): 1718-1721.
[6]	Kahrilas PJ, Bredenoord AJ, Fox M, et al. The Chicago Classifcation of Esophageal Motility Disorders, v3. 0[J]. Neurogastroenterol Motil, 2015, 7(2): 160-174.
[7]	孙晓红, 柯美云, 王智凤, 等. 非糜烂性胃食管反流病和反流性食管炎的食管动力特点[J]. 中华医学杂志, 2014, 94(22): 1718-1721.
[8]	Ho SC, Chang CS, Wu CY, et al. Ineffective esophageal motility is a primary motility disorder in gastrophaageal reflux[J]. Dig Dis Sci, 2002, 47(3): 652-656.
[9]	Katz PO, Gerson LB, vela MF. Guidelines for the diagnosis and management of gastroesophageal reflux disease[J]. Am J Gastroenterol, 2013, 108(3): 308-328.
[10]	郑松柏, 项平, 徐富星, 等. 老年人反流性食管炎1119例分析[J]. 中华老年医学杂志, 2005, 24(8): 574-576.
[11]	李兆申, 王雯, 许国铭, 等. 反流性食管炎1827例临床分析[J]. 中华内科杂志, 2001, 40(1): 9-12.
[12]	高建萍, 王虹, 顾清, 等胃食管反流病患者的临床分析[J]. 中华消化杂志, 2006, 26(5): 350-351.
[13]	郝坤艳, 林琳, 李学良, 等. 老年胃食管反流病患者临床特征分析[J]. 中华消化杂志, 2010, 30(6): 382-385.
[14]	Pilotto A, Franceschi M, Leandro G, ’et al. Clinical features of reflux esophagitis in older people: a study of 840 consecutive patients[J]. Am Geriatr Soc, 2006, 54(10): 1537-1542.
[15]	Richter JE. Gastroesophageal reflux disease in the older patient: presentation, treatment, and complications[J]. Am J Gastroenterol, 2000, 95(2): 368-373.
[16]	Ou J L, Tu C C, Hus P I, et al. Prevalence and risk factors of erosive esophagitis in Taiwan[J]. J Chin Med Assoc, 2012, 75(2): 60-64.
[17]	Aro P, Ronkainen J, Talley N J, et al. Body mass index and chronic unexplained gastrointestinal symptoms: an adult endoscopic population based study[J]. Gut, 2005, 54(10): 1377-1383
[18]	Nilsson M, Lundegardh G, Carling L, et al. Body mass index and chronic unexplained gastrointestinal symptoms: an adult endoscopic population based study[J]. Scand J Gastroenterol, 2002, 37(6): 626-630.
[19]	Corley D A, Kubo A, Zhao W. Abdominal obesity, ethnicity and gatro-oesophageal reflux symptoms[J]. Gut, 2007, 56(7): 756-762.
[20]	Luo Z, Luo J, Liu E, et al. Effects of prednisolone on refractory mycoplasma pneumoniae pneumonia in children[J]. Pediatr Pulmonol, 2014, 49(4): 377-380.
[21]	Chavez YH, Ciarleglio MM, Clarke JO, et al. Upper esophageal sphincter abnormalities frequent finding on high-resolution esophageal manometry and associated with poorer treatment response in achalasia[J]. J Clin Gastroenterol, 2015, 49(1): 17-23.
[22]	Shaker R, Babaei A, Naini SR. Prevention of esophagopharyngeal reflux by augmenting the upper esophageal sphincter pressure barrier[J]. Laryngoscope, 2014, 124(10): 2268-2274.
[23]	Fulp SR, Dalton CB, Castell JA, et al. Aging-related alterations in human upper esophageal sphincter function[J]. Am J Gastroenterol, 1990, 85(12): 1569-1572.
[24]	马欣, 彭丽华, 王潇潇, 等. 上食管括约肌异常与食管动力障碍疾病的相关性[J]. 解放军医学院学报, 2016, 37(8): 833-836.
[25]	陈帝, 王慧, 张玲, 等. 高分辨率食管测压下胃食管反流病吞咽延迟时间与食管动力的相关性研究[J]. 中华消化内镜杂志, 2014, 31(6): 304-307.
[26]	Pandolfino JE, Roman S. High-resolution manometry: an atlas of esophageal motility disorders and findings of GERD using esophageal pressure topography[J]. Thorac Surg Clin, 2011, 21(4): 465-475.
[27]	Xenos E S. The role of esophageal motility and hiatal hernia in esophageal exposure to acid[J]. Surg Endosc, 2002, 16(6): 914-920.
[28]	史伟东, 苏秉忠. 无效食管动力对胃食管反流病食管外并发症发病机制及临床意义[J]. 中华消化杂志, 2012, 32(10): 674-678.

组别	例数	UESP平均值(mmHg)	UESRP平均值(mmHg)	LESP最小值(mmHg)	LESP平均值(mmHg)	LESRP平均值(mmHg)	LESRP最大值(mmHg)	DCI(mmHg/s·cm)
NERD组	254	63.88±2.10	12.67±0.46	11.31±0.41	16.27±0.47	7.99±0.26	10.31±0.32	1 029.24±58.174
ERD组	124	58.77±3.04	9.91±0.66	7.69±0.60	11.81±0.68	6.22±0.38	8.16±0.47	731.87±88.262
P值	?	0.168	0.000 7	<0.000 1	<0.000 1	0.000 2	0.000 2	0.005 2

组别	例数	UESP平均值(mmHg)	UESRP平均值(mmHg)	LESP最小值(mmHg)	LESP平均值(mmHg)	LESRP平均值(mmHg)	LESRP最大值(mmHg)	DCI(mmHg/s·cm)
NERD组	254	63.88±2.10	12.67±0.46	11.31±0.41	16.27±0.47	7.99±0.26	10.31±0.32	1 029.24±58.174
ERD组	124	58.77±3.04	9.91±0.66	7.69±0.60	11.81±0.68	6.22±0.38	8.16±0.47	731.87±88.262
P值	?	0.168	0.000 7	<0.000 1	<0.000 1	0.000 2	0.000 2	0.005 2

洛杉矶分级	例数	UESP平均值(mmHg)	UESRP平均值(mmHg)	LESP最小值(mmHg)	LESP平均值(mmHg)	LESRP平均值(mmHg)	LESRP最大值(mmHg)	DCI(mmHg/s·cm)
LA-A	56	58.16±4.17	10.30±0.92	9.28±0.70	13.42±0.84	6.87±0.46	8.92±0.54	833.42±113.79
LA-B	43	56.54±4.17	10.43±0.92	6.47±0.70	10.57±0.84	5.57±0.46	7.47±0.54	654.94±119.34
LA-C	11	61.08±8.54	10.19±1.88	6.28±1.44	9.98±1.73	6.40±0.94	8.10±1.11	273.76±266.86
LA-D	10	61.74±8.95	9.88±1.97	6.49±1.52	10.18±1.81	5.07±0.98	6.70±1.16	447.15±285.29
P值	?	0.934	0.995	0.026	0.060	0.161	0.177	0.192

洛杉矶分级	例数	UESP平均值(mmHg)	UESRP平均值(mmHg)	LESP最小值(mmHg)	LESP平均值(mmHg)	LESRP平均值(mmHg)	LESRP最大值(mmHg)	DCI(mmHg/s·cm)
LA-A	56	58.16±4.17	10.30±0.92	9.28±0.70	13.42±0.84	6.87±0.46	8.92±0.54	833.42±113.79
LA-B	43	56.54±4.17	10.43±0.92	6.47±0.70	10.57±0.84	5.57±0.46	7.47±0.54	654.94±119.34
LA-C	11	61.08±8.54	10.19±1.88	6.28±1.44	9.98±1.73	6.40±0.94	8.10±1.11	273.76±266.86
LA-D	10	61.74±8.95	9.88±1.97	6.49±1.52	10.18±1.81	5.07±0.98	6.70±1.16	447.15±285.29
P值	?	0.934	0.995	0.026	0.060	0.161	0.177	0.192

Please choose a citation manager

Content to export