Department of Gastroesophageal Surgery, Postgraduate Training Base of Jinzhou Medical University (PLA Rocket Force Characteristic Medical Center), Beijing, China.
Department of General Surgery, Aerospace 731 Hospital, Beijing, China.
Surg Endosc. 2024 Nov;38(11):6368-6378. doi: 10.1007/s00464-024-11197-9. Epub 2024 Aug 30.
Gastroesophageal reflux disease is a prevalent condition with significant clinical variability, complicating its evaluation and treatment. The gastroesophageal flap valve is a fundamental evaluation method, but have shown limitations in specificity and reliance on subjective endoscopists' experience. Recent insights suggest that gastroesophageal junction laxity may offer an objective and quantifiable measurement for the presence of gastroesophageal reflux disease.
This retrospective study analyzed data from 401 patients who underwent comprehensive evaluations, including a symptom questionnaire, endoscopy, pH-impedance monitoring, high-resolution manometry, and treatment directions, between January 1, 2022 and October 31, 2023. Gastroesophageal junction laxity was assessed using a modified approach based on endoscopic image analysis, with the diameter of endoscope as reference to estimate the long diameter of the laxity ring. The independent association of gastroesophageal junction laxity with pathologic acid exposure, esophagitis, and hiatal hernia were assessed by adjusting with age and sex.
The mean age was 44.5 ± 5.5 years old, and 49.9% (200/401) were male. The most common symptoms (≥ 1 point) were acid regurgitation (333/401, 83.0%), heartburn (315/401, 78.6%), belching (278/401, 69.3%), bloating (241/401, 60.1%), and globus sensation (241/401, 60.1%). The gastroesophageal junction laxity was significantly associated with pathologic acid exposure, esophagitis, hiatal hernia, and lower esophageal sphincter resting pressure. Notably, with the increase in gastroesophageal junction laxity, the rates of pathologic acid exposure, esophagitis, and hiatal hernia increased gradually, the lower esophageal sphincter resting pressure decreased gradually. The gastroesophageal junction laxity was independent associated with pathologic acid exposure (OR = 2.33, 95%CI 1.77-3.07, p < 0.001), esophagitis (OR = 2.10, 95%CI 1.62-2.73, p < 0.001), and hiatal hernia (high-resolution manometry: OR = 3.39, 95%CI: 2.46-4.67, p < 0.001) (endoscopy: OR = 21.65, 95%CI 11.70-40.06, p < 0.001).
The gastroesophageal junction laxity was significantly associated with the indicators of pathophysiology in gastroesophageal reflux disease.
胃食管反流病是一种普遍存在且临床表现差异较大的疾病，这增加了其评估和治疗的难度。胃食管瓣阀是一种重要的评估方法，但特异性和对内镜医生经验的依赖存在局限性。最近的研究表明，胃食管连接部松弛可能为胃食管反流病的存在提供了一种客观且可量化的测量方法。
本回顾性研究分析了 2022 年 1 月 1 日至 2023 年 10 月 31 日期间接受综合评估的 401 例患者的数据，评估包括症状问卷、内镜检查、pH 阻抗监测、高分辨率测压和治疗方向。胃食管连接部松弛采用基于内镜图像分析的改良方法进行评估，以内镜直径为参考估计松弛环的长径。通过调整年龄和性别，评估胃食管连接部松弛与病理性酸暴露、食管炎和食管裂孔疝的独立关联。
患者平均年龄为 44.5±5.5 岁，49.9%（200/401）为男性。最常见的症状（≥1 分）为反酸（333/401，83.0%）、烧心（315/401，78.6%）、嗳气（278/401，69.3%）、腹胀（241/401，60.1%）和咽部异物感（241/401，60.1%）。胃食管连接部松弛与病理性酸暴露、食管炎、食管裂孔疝和食管下括约肌静息压显著相关。值得注意的是，随着胃食管连接部松弛程度的增加，病理性酸暴露、食管炎和食管裂孔疝的发生率逐渐增加，食管下括约肌静息压逐渐降低。胃食管连接部松弛与病理性酸暴露（比值比[OR] = 2.33，95%置信区间[CI]：1.77-3.07，p<0.001）、食管炎（OR = 2.10，95%CI：1.62-2.73，p<0.001）和食管裂孔疝（高分辨率测压：OR = 3.39，95%CI：2.46-4.67，p<0.001）（内镜：OR = 21.65，95%CI：11.70-40.06，p<0.001）独立相关。
胃食管连接部松弛与胃食管反流病的病理生理指标显著相关。
