Application Of 24-hour PH/Impedance Monitoring In Gastroesophageal Reflux Cough

Objective:Our research aims to accurately analyse the correlation relationship among nature of reflux material, acidity of reflux material, reflux time, reflux height and reflux position, to analyse the correlation between cough and reflux events,to, explore the pathogenesis and pathophysiology of GERC,so as to achieve the purposes of accurate diagnostic for GERC and provide an important basis for the treatment and prognosis of patients with GERC.Methods:1.The 120 patients with chronic cough in special outpatient for gastroesophageal reflux disease in our hospital and 30 healthy control persons were selected as research objects during the same time. The objects were informed, and accepted to this experiment. Questionnaires about general, GERD-Q scale, reflux symptom score table,SAS Scale, SDS scale, LCQ scale and cough symptom score table were filled out in ge neral and all objects were underwent endoscopy, high resolution esophageal manometry and 24-hour PH/impedance monitoring, then they were divided into RE groups and NERD group according to the results of endoscopy.2. We discussed diagnostic value of 24 h p H/ impedance technology.Patients with demeester integral ≥12.7 points and(or) SAP≥75% and were effective to treatment were diagnosed with GERC by primary standard; Patients with demeester integral ≥12.7 points and(or) SAP≥75% and(or) with abnormal results of impedance and were ineffective to treatment were diagnosed with GERC by new standards.The diagnostic rate were compared and analysed between two standards.3. We compared high-resolution esophageal manometry parameters and 24- hour esophageal p H / impedance monitoring parameters between GERC group and the healthy control group,and analyzed the characteristics of the GERC patients’ various parameters.4. In patients with GERC,we compared the similarities and differences of high resolution esophageal mano metry parameters and 24-hour esophageal p H / impedance monitoring parameters in RE group and in NERD group.5.We analyzed the Feature of GERC patients’ positioning, SAP, clinical manifestations,cough time and so on.6. We observed the proportion and composition of depression and anxiety in patients with GERC; observed the similarities and differences of HRM and 24 h p H / impedance monitoring parameters between patients with and without anxiety / depression; analyzed the correlation between SAS, SDS and GERD-Q scale score, cough symptom scores, LCQ score, reflux symptom score7. We made outpatient follow- up 4,8,12 weeks after anti-reflux treatment respectively.All objects were asked to fill in the GERD-Q scale, reflux symptom score table, LCQ scale and co ugh symptom score table scale.We observed the changes of related scale in different groups at different time, analyze improvement of GERC patients’ reflux symptoms, symptoms of cough.After 12 weeks of treatment,we evaluated the treatment efficacy based on symptoms of cough.Results:1.The 54.3 percent of patients were diagnosed as GERC by 24 h esophageal p H monitoring, while 82.8% of patients were diagnosed as GERC by 24 h esophageal p H/impedance.There with a significant difference between the two methods(P <0.01).2.high-resolution esophageal manometry:Compared with healthy controls, GERC patients’ UESP, LESP, DCI, CFV were lower than the healthy control group(P <0.01); percentage of large motility interruption and invalid swallowing in GERC group were higher than the health in the control group(P<0.01). The differences of LESP, DCI, CFV, percentage of large motility interruption and invalid swallowing between RE group and NERD group had no statistically significant(p>0.05). The UESP in RE group were lower than NERD group, the difference had a statistically significant(P<0.01).3.The 24 h p H monitoring: Compared with healthy controls,The number of p H < 4, reflux time> 5min times, the longest reflux time in GERC patients, the total time of p H <4 and time of p H <4 at upright, supine posizion accounts the percentage of monitoring time time were higher by 24 h p H monitoring. De Meester score in GERC group was higher than in control group, the difference had a statistically significant(P <0.01). Among them, the differences of number of reflux,the longest reflux time, total p H, orthostatic p H, supine p H, De Meester integration phase between RE group and NERD group had no statistically significant(p>0.05); Long reflux number in RE group were significantly higher than the number in NERD group(P <0.01).4.The 24 h impedance monitoring: Compared with healthy controls, GERC patients with various forms of reflux abnormalities, such as acid reflux, weakly acidic reflux, weak base reflux, gas reflux liquid reflux, gas- liquid mixing anti- flow, etc.the upright reflux was significantly more than supine position reflux(P <0.01). the times percentage of gas reflux, weak acid reflux and weak alkaline reflux in N ERD group were higher than RE group(p <0.01).5.Proximal reflux episodes in GERC group accounted for 57.93%(5307/9161) of the total reflux episodes, was significantly higher than 20.4%(137/672) in control group(p <0.01). Proximal reflux episodes in N ERD group accounted for 46.05%(2678/5696) of the total reflux episodes,was significantly higher than RE group(2629/3465)(p <0.01).6.GERC patients always with chronic dry cough or with a little white mucus, which associated with eating and with reflux-related symptoms.Daytime cough score was higher than nighttime cough scores(P <0.01). There was no statistically significant difference(p> 0.05) with the clinical manifestations between RE group and NERD group. SAP was positively correlated with total number of acid reflux, weakly acidic reflux episodes, gas reflux episodes and weak alkaline reflux(P <0.05).7.The proportion of GERC patients with anxiety and depression was 64.50%. Compared with GERC patients with no anxiety / depression, the UESP, LESP, DCI and CFV in GERC patients with moderate to severe anxiety / depression were much lower(P <0.01); reflux episodes, the longest reflux time, total p H, orthostatic p H, supine p H in GERC patients with moderate to severe anxiety / depression were higher(P <0.01),while gas reflux, weakly acidic reflux, weak alkaline reflux, acid reflux were lower(P <0.01). SAS, SDS scores was positively correlated with cough symptom score, GERD integration, reflux symptom score,while negatively correlated with the LCQ scale scores(P <0.01).8.According to the p H / impedance monitoring results, GERC patients were received appropriate 12 weeks treatment.GERD-Q score, cough symptom score, reflux symptom score were gradually decreased, while the LCQ score was gradually increased, there was a statistically significant difference comparing before and after treatment(P <0.01).Conclusions:1.Diagnosis rate of esophageal p H / impedance was significantly higher than 24 h esophageal p H monitoring method alone.2.The UESP, LESP and esophageal motility of GERC patients weakened,esophageal anti-reflux barrier damaged. Esophageal defenses ability in N ERD group was stronger than that in RE. UESP in RE group was low which probably related to chronic cough.3.There is p H <4 abnormal acid reflux of GERC patients. Long reflux episodes in RE group was significantly higher than that in N ERD group,while there is no difference of remaining five parameters between two groups, suggesting the duration of esophageal gastric mucosal contacting Gastric acid may be an important factor in the RE, the strength of acid reflux may play a decisive role in NERD.4.There is abnormal reflux of acid reflux material nature and PH in GERC patients. Upright position reflux is much obvious than supine position. Percentage of weak acid reflux, weak alkaline reflux and gas reflux NERD group is higher than that in RE group, suggesting that the differences of reflux types between the two groups lead to different pathogenesis.5.Distal esophageal reflux is main reflux style of GERC patients, and 57.93% of the reflux material can be available to the proximal esophagus.there are two different types of pathogenesis.6.GERC patients are mainly with chronic dry cough or a little white phlegm, mainly occur during daytime. There is no difference of Clinical manifestations between RE group and NERD group. SAP is correlated with the number of different types of reflux7.The proportion of GERC patients with anxiety and depression were higher. UESP, LESP and esophageal motor function decreased in GERC patients with moderate to severe anxiety / depression,(weakly) acidic reflux, weak alkaline reflux and gas reflux is significantly abnormal, reflux is more serious. SAS, SDS scores is correlated with the degree of cough and reflux.8.According to the p H / impedance monitoring results, GERC patients were received appropriate 12 weeks treatment, cough and reflux symptoms are improved.9.24 h p H / impedance monitoring method is superior to the simple monitoring method, which can ascertain the nature of reflux material, p H, direction of movement and height, and can be used to guide the treatment of GERC patients, provide important reference for standardization of diagnosis and treatment for GERC patients.