Department of General and Visceral Surgery, Sisters of Charity Hospital, 4010, Linz, Austria,
Surg Endosc. 2013 Dec;27(12):4590-5. doi: 10.1007/s00464-013-3071-8. Epub 2013 Jul 12.
Endoscopic grading of the gastroesophageal flap valve (GEFV) is simple, reproducible, and suggested to be a good predictor of reflux activity. This study aimed to investigate the potential correlation between grading of the GEFV and quality of life (QoL), gastroesophageal reflux disease (GERD) symptoms, esophageal manometry, multichannel intraluminal impedance monitoring (MII) data, and size of the hiatal defect.
The study included 43 patients with documented chronic GERD who underwent upper gastrointestinal endoscopy, esophageal manometry, and ambulatory MII monitoring before laparoscopic fundoplication. The GEFV was graded 1-4 using Hill's classification. QoL was evaluated using the Gastrointestinal Quality-of-Life Index (GIQLI), and gastrointestinal symptoms were documented using a standardized questionnaire. The size of the esophageal hiatus was measured during surgery by calculating the hiatal surface area (HSA). Analysis of the correlation between QoL, GERD symptoms, esophageal manometry, MII data, HSA size, and GEFV grading was performed. Statistical significance was set at a p value of 0.05.
A significant positive correlation was found between increased GEFV grade and DeMeester score, total number of acid reflux events, number of reflux events in the supine position, and number of reflux events in the upright position. Additionally, a significant positive correlation was found between HSA size and GEFV grading. No significant influence from intensity of GERD symptoms, QoL, and the GEFV grading was found. The mean LES pressures were reduced with increased GEFV grade, but not significantly.
The GEFV plays a major role in the pathophysiology of GERD. The results underscore the importance of reconstructing a valve in patients with GERD and an altered geometry of the gastroesophageal junction when they receive a laparoscopic or endoscopic intervention.
胃食管瓣（GEFV）的内镜分级简单、可重复，并且被认为是反流活动的良好预测指标。本研究旨在探讨 GEFV 分级与生活质量（QoL）、胃食管反流病（GERD）症状、食管测压、多通道腔内阻抗监测（MII）数据以及食管裂孔大小之间的潜在相关性。
本研究纳入了 43 例经证实的慢性 GERD 患者，这些患者在腹腔镜胃底折叠术前接受了上消化道内镜检查、食管测压和动态 MII 监测。使用 Hill 分类法对 GEFV 进行 1-4 级分级。使用胃肠道生活质量指数（GIQLI）评估 QoL，使用标准化问卷记录胃肠道症状。通过计算食管裂孔表面积（HSA），在手术中测量食管裂孔的大小。分析 QoL、GERD 症状、食管测压、MII 数据、HSA 大小和 GEFV 分级之间的相关性。统计学显著性设定为 p 值<0.05。
发现 GEFV 分级增加与 DeMeester 评分、总酸反流事件数、仰卧位反流事件数和直立位反流事件数呈显著正相关。此外，还发现 HSA 大小与 GEFV 分级呈显著正相关。GERD 症状强度、QoL 和 GEFV 分级对 LES 压力无显著影响。随着 GEFV 分级的增加，LES 压力呈下降趋势，但无统计学意义。
GEFV 在 GERD 的病理生理学中起主要作用。研究结果强调了在接受腹腔镜或内镜干预时，重建 GERD 患者和胃食管交界处几何结构改变患者的瓣的重要性。
