| Objective To observe characteristics of different subtypes of gastroesophageal junction(EGJ)morphology in gastroesophageal reflux disease(GERD)patients using high resolution esophageal manometry(HRM),and to study the relationship between the characteristics and esophageal peristalsis function and the effect on clinical symptoms.In order to provide new basis for diagnosis and treatment for GERD.MethodsPatients diagnosed as GERD and taking up HRM in 2015 were enrolled in this study.On the basis of Chicago Criterion 3.0,the patients were divided into three groups(Type-?,Type-?,Type-?)according to EGJ morphology.The data of the three groups were compared,which consisted of the general data,GerdQ scores,body dynamic parameters,the ratio of effective peristalsis,pressure characteristics of the upper esophageal sphincter(UES),the results of gastroscope and the constituent ratio of esophageal internal atypical symptoms and esophageal external symptoms.Results The total number of patients was 217.The number of the three groups was 174,28,15.There were statistically significant differences in mean age which was(47.7±11.01),(53.3±13.19)and(54.0±14.01),and BMI which was(22.09±3.33)Kg/m~2,(23.72±3.17)Kg/m~2,(25.68±4.60)Kg/m~2 between three groups(F=4.815,p=0.009;F=9.547,p=0.000,respectively).And there was not statistically difference between three groups in gender and Gerd-Q scores(p=0.138,0.588,respectively).The HRM results of EGJ morphology subtypes were corrected by the age and BMI.The contraction amplitude ofthe11cmaboveLESwas(52.69±2.15)mmHg,(33.62±5.4)mmHgand(32.00±7.47)mmHg.There was significant difference in 11cm amplitude between the three groups(F=7.269,p=0.001),and the other parameters didn't show significant difference between three groups(p>0.05),including the DCI,the contraction amplitude of the 3cm above LES,the amplitude of the 7cm above LES,and the ratio of effective peristalsis.By Pearson correlation analysis,the correlation coefficient between the separation distance of LES and CD and the amplitude of the 11cm above LES was-0.236(p=0.002),which showed that correlation between the separation distance and the amplitude of 11cm was negative,and there was no correlation between different subtypes of gastroesophageal junction morphology and the the other parts amplitude of esophageal body.There were no significant differences between three groups in the UES resting pressure,the UES residual pressure,the time of UES relaxation pressure to the lowest point,the UES relaxation duration time and the recovery time for relaxation(p>0.05).The number of Reflux esophagitis in three groups was 24,8,4,and there was statistically significant difference(x~2=27.128,p=0.000).There was no significant difference between three groups in the esophageal internal atypical and external symptoms(p>0.05).Conclusions The EGJ morphology subtypes was related to age and BMI,and had not relationship with gender.The changes of gastroesophageal junction morphology made esophageal peristalsis function of 11cm above LES variety,impaired the coordination of esophageal skeletal muscle and smooth muscle contraction,but not affect the contraction of the distal segment esophageal and the upper esophageal sphincter.The incidence of reflux esophagitis in Type-?and?was significantly higher than that in group Type-?,which showed that the incidence of reflux esophagitis was related to the morphological change of EGJ.The EGJ morphology subtypes was not correlated with frequency of esophageal typical symptoms(heartburn and regurgitation)of GERD.Morphological changes of gastroesophageal junction didn't directly cause esophageal internal and extra esophageal symptoms. |
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