Investigation Of Upper Esophageal Sphincter Manometry And Esophageal Motility Disorders

Backgound:Esophageal motility disorders may be caused by esophageal body dysmotility and abnormality in LES (lower esophageal sphincter) or UES (upper esophageal sphincter). It has been proved that esophageal motility disorders are associated with LES abnormality. For example, most of hiatal hernia (HH) patients showed transient lower esophageal sphincter relaxation, achalasia (AC) patients showed higher LES pressure. Furthermore, with the popularization of high resolution esophageal manometry (HRM), we now can get more accurate data which can't be ignored, such as the data of UES. UES abnormality is closely related to dysphagia, throat irritation, and so on. However, there is few research to clearly explain the clinically significant of UES abnormality. Our study mainly explores the role of UES in esophageal motility disorders; choose two typical diseases strongly identified with LES abnormalities:HH and AC, to further investigate the relationships of UES, LES, clinical symptoms and esophageal motility disorders, provide new theoretical basis for diagnosis and treatment.Aims:This study aims to evaluate the relationship between upper esophageal sphincter abnormalities and esophageal motility disorders, such as the symptoms, distribution and esophageal motility characteristics of patients.Methods:(1) We performed a retrospective study of 447 patients referred for HRM at our Digestive Endoscopic Center from Nov 2014 to Oct 2015. Patients were divided into those with normal and abnormal UES function, including hypertensive, hypotensive and impaired relaxation. Clinical and manometric profiles were compared. (2) Among them,146 patients diagnosed with achalasia underwent HRM were divided into three groups sequentially, young group(?44, n=85), middle-aged group(45-59, n=41) and older group(>60, n=20). Clinical characteristics and HRM data were compared between these groups above. (3) We performed a retrospective study of 66 patients referred for HRM at our Digestive Endoscopic Center from Jun 2014 to Apr 2015, all patients with a diagnosis of hiatal hernia underwent upper endoscopy were divided into two groups,35 patients with HH along and 31 patients with reflux esophagitis (RE). Besides, we selected 28 healthy volunteers as control to compare clinical characteristic and HRM data between the three groups.Result:(1) Patients with hypotensive UES pressure were older as compared with those with normal UES function (P<0.0001), and Patients with hypertensive UES pressure were younger as compared with those with normal UES function (P=0.012). UES impaired relaxation occurred more often in the male group than in the female (P=0.002). In respect of clinical symptom, dysphagia occurs in 69.0% of patients with UES abnormalities and 70.0% of UES impaired relaxation patients, which were significantly higher than UES normal patients (P=0.003?P<0.0001). In patients with UES impaired relaxation, classical symptoms including acid reflux and heartburn, retrosternal pain were significant lower than UES normal group (P=0.001?P=0.026). Patients with hypertensive UES resting pressure and UES impaired relaxation were significantly more likely to have achalasia ? as compared with those with normal UES function (P=0.003?P<0.0001). In additional, patients with an impaired UES were significantly more likely to have an IRP abnormality as compared with those with normal UES function (P<0.0001). (2) Compared with the controls, the LES resting pressure, IRP (Integrated relaxation pressure) and UES relaxation pressure were significantly higher in AC patients (P<0.05). IRP in young group were significant higher than older group (P=0.032), The incidence of abnormal LES resting pressure were significantly lower in older group than young group (P=0.041). Furthermore, UES resting pressure in young group were significant higher than older group (P=0.004). The incidence of low UES resting pressure were significantly higher in older group than young group (P=0.006). Conversely, the incidence of high UES resting pressure were significantly higher in young group than older group (P=0.006). The incidence rate of impaired UES relaxation was very high in different ages, the percentages are 47.1%?51.2%?40.0%, which were significantly higher than healthy population. (3) In totally 35 patients with HH along and 31 patients with RE, the typical clinical symptoms and esophageal motility disorders had no significant difference between these two groups (P>0.05). About 40% of HH patients and 45.2% of RE patients have esophageal motility disorders. LES resting pressure in RE group were significant lower than healthy group (P=0.004). The morbidity of UES hypotensive pressure was significant higher than control group (P=0.041).Conclusion:(1) Our data showed a negative correlation between age and UESP. There was a direct relationship between symptoms such as dysphagia with hypertensive UES resting pressure and impaired UES relaxation. Also, there was a high frequency of UES abnormalities observed in patients with a manometric diagnosis of achalasia II. Majority of impaired UES relaxation patients have IRP abnormalities. (2) Achalasia mostly occurs in young and middle-aged person. The prevalence of male patients is significantly declined with age increasement. The incidence rate of impaired UES relaxation in different ages were significantly higher than healthy population. Compared with older group, young group showed more obvious impaired LES relaxation and high UES resting pressure. (3) Hiatal hernia disrupt esophageal sphincter physiology function, reduced LES pressure and UES pressure makes the function of preventing acid reflux weakened. These changes may play an important role in the pathogenesis of GER and RE. (4) UES abnormalities are a frequent finding in esophageal motility disorders. HRM can provide accurate and exhaustive data to instruct to diagnosis and appraises the prognosis to play the crucial role.