Analysis Of Clinical And Motility Characteristics Of Refractory Non-Erosive Gastro-esophageal Reflux Disease Patients

Background: Gastro-esophageal reflux disease(GERD)is a common digestive tract disease.Currently,Proton Pump Inhibitors(PPI)are widely applied,and it is found that some patients with GERD presented partial or no improvement in symptoms after the routine dose of PPI drugs,which is known as Refractory gastroesophageal reflux disease(rGERD),also known as PPI treatment failure.RGERD mostly did not find significant positive signs under endoscopy,such as non-erosive gastro-esophageal reflux disease(NERD),but few patients still had reflux esophagitis(RE).High resolution manometry.HRM is an esophageal pressure measurement technique.It can measure the pressure of each segment of the esophagus clearly and accurately.And Multichannel Intraluminal Impedance and pH monitoring(MII-pH)technology can be detected within 24 h of esophageal reflux event situation,determine the presence of pathological reflux,provide the basis for further rGERD the guidance of diagnosis and treatment.However,there are different views on esophageal dysplasia in refractory gastroesophageal reflux disease and few studies on refractory non-erosive gastroesophageal reflux disease.Objective: The clinical and dynamic characteristics of refractory non-erosive gastroesophageal reflux disease were analyzed by high-resolution esophageal pressure measurement and 24hph-impedance combined monitoring.The differences of esophageal kinetic disorders between different subtypes of rGERD and between NERD and refractory NERD were analyzed.Methods: From September 2017 to September 2018,he was admitted to the department of gastroenterology,new district hospital,the first affiliated hospital of henan university of science and technology,patients aged 18-80 years old with symptoms of acid regurgitation,heartburn,belching and esophageal foreign body sensation.Complete reflux disease questionnaire(RDQ)and esophageal symptoms questionnaire.According to PPI drug use,symptoms and efficacy,patients were divided into GRED and rGERD,and the results were obtained by gastroscopy,Nonerosive gastroesophageal reflux disease(NERD group),non-erosive gastroesophageal reflux disease(refractory NERD group)and reflux esophagitis(refractory RE group)in the GERD group were included.All included patients underwent HRM and 24 hphimpedance combined monitoring to analyze the esophageal dynamics differencesbetween the groups.Results: According to relevant diagnostic criteria,36 cases of NERD group,28 cases of refractory NERD group and 10 cases of refractory RE group were included.HRM results: 1.The mean resting pressure of the inferior esophageal sphincter(LES)of the refractory nerds was higher than that of the refractory RE group and lower than that of the nerds group [13.05(10.58,16.85)mmHg;6.15(3.28,11.43)mmHg;15.70(11.70,22.78)mmHg],with statistically significant difference(P<0.05).2.Distal contraction integral(DCI)of distal contraction in refractory NERD group was813.20(721.45,894.18),mmHg was higher than that of the refractory RE group679.00(614.30,715.53)mmHg.cm.s],with statistically significant difference(P<0.05)3.The contractile front velocity(CFV)in the refractory NERD group was 2.84 cm/s(2.35,3.28)higher than that in the NERD group was 2.42 cm/s(2.00,2.74),and the difference was statistically significant(P<0.05).Combined monitoring results of 24hph-impedance:1.Acid exposure times of the refractory NERD group were 19.50(12.25,45.50)lower than those of the refractory RE group(49.00),with statistically significant difference(P<0.05).2.Demeester score of the refractory NERD group was 18.95(16.10,22.33)lower than that of the refractory RE group(31.25(24.70,43.35),and the difference was statistically significant(P<0.05).3.The number of gas-liquid mixture reflux of the refractory NERD group was 26.50(20.25,37.75)higher than that of the refractory RE group,19.50(16.25,25.25)and higher than that of the refractory NERD group14.00(11.00,22.75),with statistically significant difference(P<0.05).4.The number of weak acid reflux in the refractory NERD group was 29.50(23.00,40.50)higher than that in the refractory RE group,19.50(18.00,26.25)and higher than that in the refractory NERD group23.00(18.25,27.00),with statistically significant difference(P<0.05).Conclusion: Patients with refractory non-erosive gastroesophageal reflux disease are clinically suffering from esophageal symptoms and esophageal kinetic disorders.In addition,unlike NERD and patients with refractory RE,reflux is mostly characterized by weak acid and gas-liquid reflux,which may be one of the reasons for PPI resistance,and further mechanism remains to be studied.