Zhang Y L, Zheng Y, Zhu H T, Wang H F, Du S Y, Wang M, Lu K L
Department of Gastroenterology, China-Japan Friendship Hospital, Beijing 100029, China.
Zhonghua Yi Xue Za Zhi. 2018 Nov 27;98(44):3579-3583. doi: 10.3760/cma.j.issn.0376-2491.2018.44.006.
To investigate esophageal motility and reflux characteristics in gastroesophageal reflux disease (GERD) with and without extra-esophageal symptoms by high-resolution manometry and 24 h esophageal multichannel intraluminal impedance combined pH (MII-pH) monitoring. From February 2016 to June 2017, GERD patients with and without extra-esophageal symptoms were enrolled in this prospective controlled study. Esophageal HRM and 24 h MII-pH monitoring were performed. The differences in esophageal motility and reflux parameters were further analyzed between 30 GERD patients with extra-esophageal symptoms and 30 simple GERD patients. The GERD symptom scores didn't show statistical difference between two groups. The GERD symptom scores didn't show statistical difference between two groups. The relaxation pressure of lower esophageal sphincter(LES), the integrated relaxation pressure, and the recovery time of upper esophageal sphincter(UES) of GERD patients with extra-esophageal symptoms were all lower than those of patients without extra-esophageal symptoms [(15±7) vs (21±11)mmHg, (8±3) vs (10±5)mmHg, (388±168) vs (492±170)ms, 1 mmHg=0.133 kPa], and the differences were statistically significant(all <0.05). The main classification of esophageal motility type of GERD patients with extra-esophageal symptoms was mild esophageal motility disorders (27%, 8/30), and the occurrence of ineffective esophageal motivation was 20% (6/30), which were similar with simple GERD patients. The proximal reflux percentages of weak acid reflux and nonacid reflux, abnormal nonacid reflux in GERD patients with extra-esophageal symptoms were significantly higher than those in simple GERD patients [84.6% (73.2%, 100.0%) vs 75.0% (60.0%, 87.65%), =0.048; 90.0% (45.8%, 100.0%) vs 0(0, 100.0%), =0.017; 46.7% vs 3.3%, =0.03]. The pathogenesis of GERD with extra-esophageal symptoms may be different from typical GERD. Increase of proximal esophageal reflux and abnormal nonacid reflux may all participate in the mechanisms of GERD with extra-esophageal symptoms.
通过高分辨率测压法和24小时食管多通道腔内阻抗联合pH（MII-pH）监测，研究有无食管外症状的胃食管反流病（GERD）患者的食管动力和反流特征。2016年2月至2017年6月，将有无食管外症状的GERD患者纳入这项前瞻性对照研究。进行食管高分辨率测压（HRM）和24小时MII-pH监测。进一步分析30例有食管外症状的GERD患者和30例单纯GERD患者之间食管动力和反流参数的差异。两组GERD症状评分无统计学差异。有食管外症状的GERD患者的食管下括约肌（LES）松弛压、综合松弛压和食管上括约肌（UES）恢复时间均低于无食管外症状的患者[（15±7） vs （21±11）mmHg，（8±3） vs （10±5）mmHg，（388±168） vs （492±170）ms，1 mmHg = 0.133 kPa]，差异有统计学意义（均<0.05）。有食管外症状的GERD患者食管动力类型的主要分类为轻度食管动力障碍（27%，8/30），无效食管动力的发生率为20%（6/30），与单纯GERD患者相似。有食管外症状的GERD患者弱酸反流和非酸反流的近端反流百分比以及异常非酸反流均显著高于单纯GERD患者[84.6%（73.2%，100.0%） vs 75.0%（60.0%，87.65%），P = 0.048；90.0%（45.8%，100.0%） vs 0（0，100.0%），P = 0.017；46.7% vs 3.3%，P = 0.03]。有食管外症状的GERD的发病机制可能与典型GERD不同。食管近端反流增加和异常非酸反流可能均参与了有食管外症状的GERD的发病机制。
