Xie Chenxi, Li Yuwen, Zhang Ning, Xiong Lishou, Chen Minhu, Xiao Yinglian
Department of Gastroenterology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong Province, 510080, People's Republic of China.
BMC Gastroenterol. 2017 Nov 22;17(1):118. doi: 10.1186/s12876-017-0693-7.
The anatomy of esophagogastric junction (EGJ) serves as the anti-reflux barrier. The gastroesophageal flap valve (GEFV) is a component of EGJ. The aim of the current study was to assess its correlation with the esophageal acid exposure and the impact on anti-reflux barrier function by using the metrics of EGJ contraction.
Eighty three patients with typical GERD symptoms were included in the study. Upper endoscopy, high-resolution manometry (HRM) and 24 h multichannel intraluminal impedance-pH (MII-pH) monitoring were performed in all patients. GEFV was determined as four grades during endoscopic examination based on the Hill classification. The esophageal pressure topography (EPT) metrics defined in the updated Chicago Classification were measured by HRM, including integrated relaxation pressure (IRP), EGJ contractile index (EGJ-CI),expiratory EGJ pressure(EGJP-exp) and inspiratory EGJ pressure (EGJP-insp).
The GEFV grade III and IV was more commonly found in patients with esophagitits (p < 0.05). The acid exposure time (AET%) and supine AET% were lower in patients with GEFV grade I (p < 0.01). There was weak correlation between AET% and GEFV grades (r = 0.27, p = 0.013). There were more EGJ morphology type III in patients with GEFV grade IV (p < 0.05).There were no significant differences on the values of four HRM metrics among the patients with different GEFV grades (p > 0.05).
The GEFV grades were associated with acid reflux positively and could be a good reflection of EGJ morphology in HRM. But it had no impact on the four HRM metrics. Our research revealed that GEFV may play an assistant role in the anti-reflux barrier.
食管胃交界部（EGJ）的解剖结构构成抗反流屏障。胃食管瓣阀（GEFV）是EGJ的一个组成部分。本研究的目的是通过使用EGJ收缩指标来评估其与食管酸暴露的相关性以及对抗反流屏障功能的影响。
83例有典型胃食管反流病（GERD）症状的患者纳入本研究。所有患者均接受了上消化道内镜检查、高分辨率测压（HRM）和24小时多通道腔内阻抗-pH（MII-pH）监测。在内镜检查期间，根据希尔分类法将GEFV分为四个等级。通过HRM测量更新后的芝加哥分类法中定义的食管压力地形图（EPT）指标，包括综合松弛压（IRP）、EGJ收缩指数（EGJ-CI）、呼气时EGJ压力（EGJP-exp）和吸气时EGJ压力（EGJP-insp）。
食管炎患者中更常见GEFVⅢ级和Ⅳ级（p<0.05）。GEFVⅠ级患者的酸暴露时间（AET%）和仰卧位AET%较低（p<0.01）。AET%与GEFV等级之间存在弱相关性（r=0.27，p=0.013）。GEFVⅣ级患者中EGJ形态Ⅲ型更多（p<0.05）。不同GEFV等级患者的四个HRM指标值无显著差异（p>0.05）。
GEFV等级与酸反流呈正相关，并且在HRM中可以很好地反映EGJ形态。但它对四个HRM指标没有影响。我们的研究表明，GEFV可能在抗反流屏障中起辅助作用。
