Lin Si Hui, Wang Zhi Feng, Li Hua, Sun Xiao Hong, Li Xiao Qing, Fei Gui Jun, Chen Wei Guang, Guo Tao, Ke Mei Yun, Fang Xiu Cai
Departement of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Department of Gastroenterology, The First Affiliated Hospital of Xiamen University, Xiamen, Fujian Province, China.
J Dig Dis. 2025 Sep 1. doi: 10.1111/1751-2980.70007.
The association between reflux events and esophageal motility abnormality is unclear. We aimed to determine the relevance between reflux events and esophageal motility in proton pump inhibitor (PPI)-refractory gastroesophageal reflux disease (GERD).
Patients with PPI-refractory or PPI-responsive GERD were enrolled. Ambulatory 24-h esophageal pH-impedance-pressure monitoring was performed. Reflux symptoms, reflux events, and esophageal motility during acid reflux episodes were recorded and compared between the two groups.
Sixty patients with PPI-refractory GERD and 18 with PPI-responsive GERD were included, all of whom had pathological gastroesophageal reflux. There were no significant differences in the major acid reflux parameters (DeMeester score and proportion of patients with acid exposure time > 6%) between the two groups. However, the number of long acid reflux episodes and the time length of the longest reflux episodes were significantly higher in the PPI-refractory GERD group than in the PPI-responsive GERD group (both p < 0.05). Moreover, patients with PPI-refractory GERD had higher rates of ineffective primary (62.0% vs. 36.0%, p < 0.001) and secondary peristalsis (83.5% vs. 57.0%, p = 0.001) during long acid exposure (LAE) than those with PPI-responsive GERD. Patients with PPI-refractory GERD having LAE had a significantly lower frequency of primary and secondary peristalsis per minute and required a longer time to initiate secondary peristalsis than those without during their longest acid reflux period in the upright position (all p < 0.001).
Longer acid reflux episodes in patients with PPI-refractory GERD might result from frequent ineffective primary esophageal peristalsis and delayed initiation of effective secondary peristalsis.
反流事件与食管动力异常之间的关联尚不清楚。我们旨在确定质子泵抑制剂（PPI）难治性胃食管反流病（GERD）中反流事件与食管动力之间的相关性。
纳入PPI难治性或PPI反应性GERD患者。进行24小时动态食管pH-阻抗-压力监测。记录两组患者在酸反流发作期间的反流症状、反流事件和食管动力，并进行比较。
纳入60例PPI难治性GERD患者和18例PPI反应性GERD患者，所有患者均有病理性胃食管反流。两组之间主要酸反流参数（DeMeester评分和酸暴露时间>6%的患者比例）无显著差异。然而，PPI难治性GERD组的长时间酸反流发作次数和最长反流发作时间明显高于PPI反应性GERD组（均p<0.05）。此外，在长时间酸暴露（LAE）期间，PPI难治性GERD患者的无效原发性蠕动（62.0%对36.0%，p<0.001）和继发性蠕动（83.5%对57.0%，p=0.001）发生率高于PPI反应性GERD患者。在直立位最长酸反流期间，有LAE的PPI难治性GERD患者每分钟原发性和继发性蠕动频率明显低于无LAE者，且启动继发性蠕动所需时间更长（均p<0.001）。
PPI难治性GERD患者较长时间的酸反流发作可能是由于原发性食管蠕动频繁无效和继发性有效蠕动启动延迟所致。
