Analysis Of Motility Characteristics And Causes Of Patients With Esophageal Chest Pain

Objective: To analyze the causes and esophageal motility characteristics of patients with esophageal chest pain(ECP)by esophageal high resolution manometry(HRM)and 24-hour esophageal pH/Impedance monitoring,and study the esophageal motility change in patients with gastroesophageal reflux disease(GERD).Methods: Analysis of the patients with esophageal chest pain by clinical and cardiovascular examination from department of gastroenterology in Dalian municipal central hospital from 2014 January to October 2015,and 10 healthy volunteers were enrolled as the controlled group.The research objects were examined by HRM and 24 hours PH/ impedance monitoring.Analysis the esophageal motility change in patients diagnosed GERD.Record the parameters and compare their difference in each group.Results:1.The ratio of male of 108 patients was 0.93:1,aged 21 to 83 years old,average 56.85±13.4 years old.102 cases of patients with esophageal motility disorder,including 50 cases of nonspecific esophageal movement disorders(NEMD),41 cases of GERD,7 cases of esophageal hiatal hernia(HH),diffuse esophageal spasm in 1 case and 3 cases of achalasia of the cardia.2.102 cases of ECP patients in NEMD?GERD?HH with LES dysfunction accounted for 54%,58.5% and 58.5%,respectively,of which the most common for LESP decreased.3.The upper esophageal sphincter length(UESL)and the upper esophageal sphincter pressure(UESP)in RE group and NERD group had no significant differences in comparison of control group(P>0.05),and the difference was not statistically significant between RE group and NERD group(P> 0.05).UESP in RE merge HH group was lower than control group,the difference was significant difference(P<0.05).Both the lower esophageal sphincter length(LESL)and lower esophageal sphincter pressure(LESP)decreased in RE group?NERD group?RE merge HH group in comparison of control group,the difference was statistically significant(P<0.05),and the differences in RE merge HH group were more significant than RE group and NERD group(P<0.05).The DCI of esophageal body in RE group?NERD group and RE merge HH group were lower than the control group,the difference was statistically significant(P<0.05),and the differences in NERD group were more significant than RE group and RE merge HH group with P<0.05.The DL of esophageal body in RE group?NERD group and RE merge HH group were higher than the control group,the difference was statistically significant(P<0.05).4.The most common abnormal contraction of NEMD ? GERD and HH patients was weak peristaltic contraction,secondly,for the loss of peristaltic contraction.50 cases of NEMD with body motility dysfunction was40%,which loss of peristaltic contraction was 4%?weak peristaltic contraction was 34%?excessive peristaltic contraction was 2%.41 cases of GERD with body motility dysfunction was34.1%,which loss of peristaltic contraction was 4.88%?weak peristaltic contraction was 26.8%?excessive peristaltic contraction was 2.4%.7 cases HH with body motility dysfunction was 42.9%,all showed weak peristalsis.5.In GERD patients,the positive diagnosis of 24-hour esophageal pH/Impedance monitoring was the highest,and the highest diagnostic rate of NERD patients.Endoscopic diagnosis of RE patients was the highest,but for the NERD was just an exemplary examination.6.41 cases of patients with 24-hour esophageal pH/Impedance monitoring positive for 31 cases,the most common in GERD patients was acid flux,reflux properties in gas reflux was the most common.7.The acid reflux episodes?acid reflux >5min times?the longest acid reflux group?the percentage of time that<4 in 24 hours?the percentage of time that<4 in sitting position?the percentage of time that<4 in supine position?DeMeester score in 41 cases of GERD patients(including RE group?NERD group?RE merge HH group)were higher in comparison of control group,the difference was statistically significant(P<0.05),and the differences in RE were more significant than RE merge HH group and NERD group(P<0.05)in acid reflux episodes?acid reflux >5min times?the longest acid reflux group?the percentage of time that<4 in 24 hours?the percentage of time that<4 in sitting position and DeMeester score.Conclusions : 1.The pathogenesis of ECP patients is diverse,the common cause is esophageal motility disorders,such as NEMD,followed by GERD.2.ECP patients with esophageal motility disorders exist,esophageal body motility abnormalities and LESP reduce may be an important reason for ECP.3.The role of UES in GRED patients may have no effect on its possible impact,mainly LES changes.The LES anti-reflux and esophageal body motility abnormalities in different subtypes of GERD may be different.4.Most common abnormal contraction of ECP patients may be weak peristaltic contraction,secondly,followed by loss of peristaltic contraction.5.The positive diagnosis rate of GERD by HRM combined with 24-hour esophageal pH/Impedance monitoring is highest.HRM combined with 24-hour esophageal pH/Impedance monitoring may be the important method in the diagnosis of GERD.6.One of the most important reasons in the pathogenesis of GERD may be acid reflux,followed by weak acid reflux,partially confirmed non-acid reflux in GERD.The most common of properties may be gas reflux.7.RE group in GERD patients of acid reflux may be more severe than in NERD group.