| Background and purpose: The diagnostic criteria of high-resolution esophageal manometry is Chicago classification,which is based on normative values established from ten liquid swallows,but the manometric results are different when swallowing different bolus.Ineffective esophageal motility(IEM)is a common abnormal motility in gastroesophageal reflux disease,and it is not rare in normal people.Currently,the research on IEM is mainly limited to the liquid swallows of gastroesophageal reflux disease in a small sample and single center.we tried to compare esophageal peristalsis type and parameters between liquid and solid swallows in healthy volunteers with multiple center and large sample,and to investigate the distribution of ineffective contraction during different bolus swallows in healthy Chinese subjects.Methods: The study was conducted in 11 hospitals in different parts of China.110 asymptomatic health volunteers were recruited to complete high resolution esophageal manometry with the same equipment in accordance with the unified process.After the routine rest and ten liquid swallows,ten solid bread swallows were added in all participants.According to the Chicago classification,the esophageal motility of liquid swallowing were analyzed,while bread swallows refers to the standard of solid swallows reported in the literature.In this study,we compared the distribution of ineffective contractions and the consistency of the diagnosis for liquid and solid swallows.The normal data of the distal contractile integral(DCI),the distal latency(DL)and the 4s integrated relaxation pressure(4s IRP)in China were analyzed.Results:1.After excluding nine abnormal samples,The parameters of esophageal manometry in101 volunteers were displayed as(mean ± standard deviation,P95).Liquid swallows:IRP(9.8±4.4,18.2)mm Hg,DCI(1207.5±756.2,2757.7)mm Hg.s.cm,DL(6.8±1.2,9.0)s;solid swallows: IRP(9.7±4.7,17.3)mm Hg,DCI(1737.7±1100.3,3865.6)mm Hg.s.cm,DL(9.3±2.4,13.9)s.Longer DL(P<0.001)and higher DCI(P<0.001)were seen in solid swallows,while 4s IRP showed no statistical difference for different boluses.2.Ineffective contractions are common in both liquid and solid swallows.In addition to17 healthy subjects,the remaining 84 volunteers had at least one ineffective contraction during either liquid or solid swallows.For liquid swallows,24(23.8%)had failed peristalsis and 46(45.5%)had weak contraction.For solid swallows,44(43.6%)had failed peristalsis and 68(67.3%)had weak contraction.Ineffective swallows was seen in 53(52.5%)subjects during liquid swallows and 75(75.2%)individuals in solid swallows.3.Among 101 volunteers,25 subjects had the same proportion of ineffective contractions.Esophageal peristalsis of 17 subjects were normal during the whole process,and 8subjects had the same number of ineffective contractions when swallowing liquid and solid bolus.The number of ineffective swallows of the remaining 76 were not consistent during liquid and solid swallows.Among them,31 volunteers had normal liquid swallows and 10%-90% ineffective solid swallows,8 volunteers had 10%-50%ineffective swallows and normal solid swallows.27 volunteers had more ineffective contractions in solid swallows than liquid swallows,while the other 10 volunteers were opposite.4.Of the 101 subjects,16(15.8%)had inconsistent manometric diagnosis of liquid swallows and solid swallows.9(8.9%)of the participants were diagnosed as IEM in water swallows but normal in solid swallows,7(6.9%)of the subjects were diagnosed IEM in solid swallows but normal in water swallows.85(84.2%)of the subjects had the same diagnosis,4(4.0%)had IEM and 81(80.2%)were normal for both water and solid swallows.Conclusion: Ineffective swallows were frequently seen in healthy individuals.The adding of solid swallows might cause diagnostic change.The esophageal manometry was not the same when swallowing different bolus,specific solid diagnostic criteria should be applied in evaluation of ineffective esophageal motility in solid swallows.Background and purpose: Esophageal manometry can record pressure changes in various parts of the esophagus during swallows,whereas hardly visualizes bolus clearance.High resolution impedance manometry can simultaneously monitor the esophageal motility and bolus transit,allowing esophageal functional assessment of individual swallows.Ineffective contractions are common in normal people,but the relation between ineffective contraction and abnormal bolus emptying is still unclear.The aim of the study is to invest the esophageal body peristalsis and bolus clearance in normal subjects by high resolution impedance manometry,and to explore the esophageal motility of abnormal bolus clearance in different test meals.Methods: Twenty-two asymptomatic healthy subjects were recruited to undergo upper gastrointestinal endoscopy,high resolution impedance esophageal manometry and 24-hour p H monitoring.All subjects were given 5ml normal saline,5ml viscous material and 2cm ×2cm × 2cm solid bolus,each of which was swallowed 10 times.The manometric data of three kinds of test meals were collected to observe the emptying of bolus during swallows and analyze the the motility of abnormal bolus clearance.Results:1.5 subjects with abnormal p H monitoring were excluded and 17 volunteers were included in the study.3(17.6%)subjects had abnormal bolus transit in liquid swallows,5(29.4%)subjects had abnormal bolus transit in viscous swallows,7(41.1%)subjects had abnormal bolus transit in solid swallows.2.In the swallowing of liquid and viscose,all abnormal bolus transit showed ineffective swallows.The type of esophageal body contraction corresponding to most abnormal solid bolus clearance was ineffective swallows,and a few showed premature contraction.The bolus transit of ineffective contraction is not only impaired but also normal.3.Viscous swallows(6.5%,11/170)were more likely to have abnormal bolus transit than liquid swallows(1.8%,3/170,P=0.029),solid swallows(13%,22/170)had more abnormal bolus transit than liquid(P=0.044)and viscous swallows(P<0.001).The abnormal bolus transit of water swallows was within 10%,which was up to 40% for viscose swallows and 70% for solid swallows.4.41.1%(7/17)of the volunteers had complete bolus clearance and one subject had impaired bolus clearance during three test meals.Three people had abnormal bolus transit for at least two kinds of bolus,the remaining six subjects had abnormal bolus transit for one kind of bolus.5.Longer DL(P<0.001)was seen in viscous swallows than liquid swallows.Solid swallows had longer DL(P<0.001)and higher DCI(P<0.001)than liquid and viscous swallows.The esophageal body pressure parameters of 17 healthy subjects were shown in the form of(mean±standard deviation,P95).Liquid swallows: IRP(7.7±2.4,12.8)mm Hg,DCI(1549.8±779.4,2730.4)mm Hg.s.cm,DL(6.2±1.2,8.2)s,viscous swallows: IRP(7.2±3.0,12.8)mm Hg,DCI(1501.8±747.8,2552.8)mm Hg.s.cm,DL(7.0±1.7,10.1)s;solid swallows: IRP(7.8±3.8,14.5)mm Hg,DCI(2982.5±1467.5,5741.3)mm Hg.s.cm,DL(9.7±2.5,13.9)s.Conclusion: It is not uncommon for normal people to have impaired bolus clearance.The esophageal motility corresponding to abnormal bolus transit in different bolus test meals is mostly ineffective contraction.Background and purpose: Acid reflux is the most important factor of gastroesophageal reflux disease(GERD).However,almost half of the patients who use proton pump inhibitors(PPIs)have poor efficacy.Low grade esophagitis(Los Angeles Classification A or B)was not considered to be conclusive evidence for GERD in Lyon consensus,there are few studies focus on acid reflux in low grade esophagitis.This study compared the esophageal motility and clinical characteristics of patients with and without excessive acid reflux,and tried to explore the differential factors between low grade esophagitis patients with pathological and physiological acid reflux,so as to guide the acid suppression treatment.Methods: Consecutive patients who were undergoing high resolution esophageal manometry(HRM)and 24 h dynamic p H monitoring at the gastrointestinal motility laboratory from January 2010 to August 2018 was retrospectively searched and included.Low grade esophagitis were diagnosed by gastroscope in three months and divided into pathological and physiological acid reflux groups according to the 24-hour p H monitoring.Demographics information,the frequency and severity of back food,acid reflux,heartburn,chest pain and extraesophageal symptoms of all participants were collected routinely before examination.The resting state and ten liquid swallows were recorded during HRM.EGJ classification,LES pressure and IEM were diagnosed based on the Chicago criteria.Finally,24-hour p H monitoring was performed to analyze the De Meester score,acid exposure time,reflux events,long reflux times and the longest reflux time.Results:1.Ninety six patients with low grade esophagitis were included in the study,of which29(30.2%)had pathological acid reflux.No difference was found for the sex,age,body mass index,alcohol consumption and smoking habits between pathological acid reflux group and physiological acid reflux group.2.The occurrence of EGJ type(P=0.615)and the low LESP(P=0.215)were comparable between pathological and physiological acid reflux group.It seemed that more patients with pathological acid reflux were diagnosed as IEM,but the difference was not statistically significant(55.2% vs 34.3%,P=0.052).However,in patients with abnormal acid reflux,the frequency of ineffective liquid contraction was higher(median frequency 80% vs 20%,P=0.002).3.Compared with patients with physiological acid reflux,patients with pathological acid reflux had higher De Meester score(median 28.3 vs 5.7,P<0.001),longer acid exposure time(8.1 vs 1.3,P<0.001),more acid reflux events(89 vs 24,P<0.001),more patients with long-term acid reflux(96.6% vs 38.8%,P<0.001),and longer duration of longest gastric acid reflux(17.4min vs 7.8min,P<0.001).4.The severity and frequency of esophageal and extraesophageal symptoms between the pathological and physiological acid reflux groups.The RDQ score of two groups did not differ significantly(10 vs 8,P=0.330).Conclusion: The incidence of pathological acid reflux in patients with low grade esophagitis is not high(30.2%).Demographic,reflux symptoms and most high resolution esophageal manometry parameters are similar between pathological and physiological acid reflux groups.Severe IEM might be the only possible predictor of the low grade esophagitis with pathological acid reflux. |
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