Kim Gwang Ha, Kang Dae Hwan, Song Geun Am, Kim Tae Oh, Heo Jeong, Cho Mong, Kim Jin Seon, Lee Byung Joo, Wang Soo Geun
Department of Internal Medicine, Pusan National University College of Medicine, 1-10 Ami-dong, Seo-gu, Busan, 602-739, Korea.
J Gastroenterol. 2006 Jul;41(7):654-61. doi: 10.1007/s00535-006-1819-9.
The endoscopic grade of the gastroesophageal flap valve (GEFV) is suggested to be a good predictor of reflux status. The aim of this study was to investigate the association of the GEFV and gastroesophageal and gastropharyngeal reflux.
A total of 364 patients (151 men and 233 women; mean age, 52.2 years) who underwent endoscopy, esophageal manometry, and ambulatory 24-h dual-probe pH monitoring were included. GEFV was graded I through IV using Hill's classification; then, GEFV was classified into two groups: a normal GEFV group (grades I and II) and an abnormal GEFV group (grades III and IV). Findings of endoscopy, esophageal manometry, and ambulatory pH monitoring were compared between the groups.
Increased GEFV grade was significantly associated with an increased prevalence of both reflux esophagitis and Barrett's epithelium (P < 0.001). Lower esophageal sphincter pressure was significantly lower in the abnormal GEFV group than in the normal GEFV group (P < 0.001). All variables showing gastroesophageal reflux in the distal probe were significantly higher in the abnormal GEFV group than in the normal GEFV group (P < 0.001). In addition, all variables, except the supine time of pH < 4, showing gastropharyngeal reflux in the proximal probe were significantly higher in the abnormal GEFV group than in the normal GEFV group (P < 0.001). The frequency of gastroesophageal reflux disease and of gastropharyngeal reflux disease was significantly higher in the abnormal GEFV group than in the normal GEFV group (P < 0.001).
Endoscopic grading of the GEFV is easy and provides useful information about the status of gastroesophageal and gastropharyngeal reflux.
胃食管瓣阀（GEFV）的内镜分级被认为是反流状态的良好预测指标。本研究的目的是调查GEFV与胃食管反流和胃咽反流之间的关联。
总共纳入了364例患者（151例男性和233例女性；平均年龄52.2岁），这些患者均接受了内镜检查、食管测压和24小时动态双探头pH监测。GEFV采用希尔分类法分为I至IV级；然后，GEFV被分为两组：正常GEFV组（I级和II级）和异常GEFV组（III级和IV级）。比较两组在内镜检查、食管测压和动态pH监测方面的结果。
GEFV分级增加与反流性食管炎和巴雷特上皮的患病率增加显著相关（P < 0.001）。异常GEFV组的食管下括约肌压力显著低于正常GEFV组（P < 0.001）。异常GEFV组远端探头显示胃食管反流的所有变量均显著高于正常GEFV组（P < 0.001）。此外，除了近端探头pH < 4的仰卧时间外，异常GEFV组近端探头显示胃咽反流的所有变量均显著高于正常GEFV组（P < 0.001）。异常GEFV组的胃食管反流病和胃咽反流病的发生率显著高于正常GEFV组（P < 0.001）。
GEFV的内镜分级简单易行，可提供有关胃食管反流和胃咽反流状态的有用信息。
