Ham Hyoju, Cho Yu Kyung, Lee Han Hee, Yoon Seung Bae, Lim Chul-Hyun, Kim Jin Su, Park Jae Myung, Choi Myung-Gyu
Department of Internal Medicine, The College of Medicine, The Catholic University of Korea, Seoul, Korea.
J Gastroenterol Hepatol. 2017 Aug;32(8):1443-1449. doi: 10.1111/jgh.13720.
We evaluated associations of esophagogastric junction (EGJ) metrics as an anti-reflux barrier with impedance-pH, endoscopic esophagitis, and lower esophageal sphincter (LES) metrics.
We reviewed high-resolution manometry data from consecutive patients with gastroesophageal reflux disease (GERD) symptoms who underwent impedance-pH and endoscopy, and asymptomatic volunteers. The EGJ contractile integral (CI) was calculated as the mean contractile integral/second during three respiratory cycles. EGJ morphology was classified according to LES-crural diaphragm (CD) separation.
In total, 137 patients (65 male, age 55 years) and 23 (9 male, age 33 years) controls were enrolled. Twenty-five patients had erosive reflux disease (ERD), 16 had non-erosive reflux disease (NERD), 5 had reflux hypersensitivity, and 91 were not GERD. EGJ-CI were lower in patients with GERD (22.6 [13.8-29.2] mmHg cm) than non-GERD (50.3 [31-69.9] mmHg cm, P < 0.01) and controls (67 [26.7-78.7] mmHg cm). With an EGJ-CI cut-off value of 30 mmHg cm, the area under the curve was 0.814 (0.762-0.896), with 77.8% sensitivity and 81.7% specificity for the prediction of GERD. LES-CD separation was greatest in patients with ERD, followed the NERD, non-GERD, and controls. EGJ morphology type III was associated with a higher DeMeester score (7.9 [1.6-12.6]) than were type II (3.25 [0.9-5.975]) and I (1.75 [0.8-6.2]; P < 0.01). EGJ-CI values were lower in patients with GERD than in others in each EGJ morphology subgroup.
Esophagogastric junction contractile integral showed good diagnostic accuracy with high specificity in predicting GERD. LES-CD separation is associated with an increase in acid reflux, but EGJ-CI was associated more strongly with GERD than was EGJ morphology.
我们评估了食管胃交界（EGJ）指标作为抗反流屏障与阻抗-pH、内镜下食管炎及食管下括约肌（LES）指标之间的关联。
我们回顾了连续的有胃食管反流病（GERD）症状且接受了阻抗-pH检查和内镜检查的患者以及无症状志愿者的高分辨率测压数据。EGJ收缩积分（CI）计算为三个呼吸周期内的平均收缩积分/秒。EGJ形态根据LES-膈脚（CD）分离情况进行分类。
共纳入137例患者（65例男性，年龄55岁）和23例对照（9例男性，年龄33岁）。25例患者患有糜烂性反流病（ERD），16例患有非糜烂性反流病（NERD），5例患有反流高敏症，91例不是GERD患者。GERD患者的EGJ-CI（22.6 [13.8 - 29.2] mmHg·cm）低于非GERD患者（50.3 [31 - 69.9] mmHg·cm，P < 0.01）和对照（67 [26.7 - 78.7] mmHg·cm）。以EGJ-CI截断值30 mmHg·cm计算，曲线下面积为0.814（0.762 - 0.896），预测GERD的敏感性为77.8%，特异性为81.7%。LES-CD分离在ERD患者中最大，其次是NERD患者、非GERD患者和对照。EGJ形态III型的DeMeester评分（7.9 [1.6 - 12.6]）高于II型（3.25 [0.9 - 5.975]）和I型（1.75 [0.8 - 6.2]；P < 0.01）。在每个EGJ形态亚组中，GERD患者的EGJ-CI值均低于其他患者。
食管胃交界收缩积分在预测GERD方面具有良好的诊断准确性和高特异性。LES-CD分离与酸反流增加有关，但EGJ-CI与GERD的关联比EGJ形态更强。
