| Objectives The regurgitation and heartburn symptom are common gastrointestinal symptoms.With the development of society,the number of people with the symptoms increases year by year.The typical symptoms of patients with gastroesophageal reflux disease(GERD),reflux hypersensitivity(RH)and functional heartburn(FH)are regurgitation and heartburn.It was difficult to distinguish between the three diseases by medical history,and now mainly depends on 24-hour p H-impedance monitoring,but the widespread application of this monitoring has certain difficulties.Current research shows that GERD,RH,and FH all have different degrees of esophageal motility problems.In this study,by analyzing the characteristics of various parameters of esophageal high-resolution manometry(HRM)in 136 patients with regurgitation and heartburn symptoms,the aim was to further clarify the dynamic characteristics of patients with regurgitation and heartburn symptoms.Methods 136 patients with regurgitation and heartburn symptoms who were admitted to the Hebei General Hospital from March 2018 to February 2020 were included.Complete the regurgitation symptom score and gastroesophageal reflux disease questionnaire(Gerd Q),gastroscopy,HRM,24-hour p H-impedance monitoring,and divide patients into GERD group,RH group and FH group according to the results of gastroscopy and 24-hour p H-impedance examination.Analyze and compare the proportions of GERD group,RH group and FH group.Analyze the gap between the regurgitation symptom score and Gerd Q between the three groups.Analyze the parameters of esophageal high-pressure manometry and the relationship between esophageal motility and acid exposure among the three groups.Results 1 Among the 136 patients with regurgitation and heartburn symptoms,36.0%(49/136)were in the GERD group,14.7%(20/136)in the RH group,and 49.3%(67/136)in the FH group.2 Among the three groups of patients,only the GERD group(6.00(4.00,11.00)points)patients were significantly higher than the FH group(4.00(4.00,7.00)points),the difference was statistically significant(P<0.05).Among the three groups of patients,only Gerd Q scores was significantly higher in the GERD group(9.00(6.50,11.00)points)than in the FH group(6.00(6.00,8.00)points),the difference was statistically significant(P<0.05).3 The lower esophageal sphincter resting pressure(LESP)of GERD group((15.00±4.74)mm Hg)was lower than RH group((18.25±3.89)mm Hg),lower than FH group((22.01 ± 6.46)mm Hg),the difference was statistically significant(P =0.000 among the three groups;GERD group vs.FH group,GERD group vs.RH group,RH group vs.FH group,P<0.05).According to the diagnostic criteria for crural diaphragmlower esophageal sphincter(CD-LES)classification in Chicago 3.0,The proportion of CDLES type II and type III patients(36.7%)in the GERD group was higher than that in the RH group(30.0%)and FH group(20.9%),but the difference was not statistically significant(P>0.05).The esophagogastric junction contractile integral(EGJ-CI)of GERD group(24.35±7.88 mm Hg × cm)was lower than the RH group(30.27±4.76 mm Hg × cm),lower than the FH group(39.03±12.07 mm Hg × cm),the difference was statistically significant(P = 0.000 among the three groups;GERD group vs.FH group,GERD group vs.RH group,RH group vs.FH group,P<0.05).4 The distal contractile integral(DCI)of RH group(700.00(502.74,719.58)mm Hg×s×cm)was lower than the GERD group(764.00(699.10,782.25)mm Hg × s × cm),lower than the FH group(1089.00(997.00,1359.00)mm Hg×s×cm),the difference was statistically significant(P = 0.000 among the three groups;GERD group vs.FH group,GERD group vs.RH group,RH group vs.FH group,P<0.05).The distal latency(DL)among the three groups was only significantly longer in the RH group(6.67(5.93,6.90)s)than in the GERD group(5.90(5.50,6.20)s),and the difference was statistically significant(P<0.05).There was no statistically significant difference among the three groups of patients in the contractile front velocity(CFV)(P>0.05).The median of integrated relaxation pressure(m IRP)of the RH group((10.88±4.11)mm Hg)was higher than that of the GERD group((7.99±2.17)mm Hg)and the FH group((8.61±4.08)mm Hg),the difference was statistically significant(P = 0.009 among the three groups;RH group vs.GERD group and RH group vs.FH group,P<0.05).There was no statistically significant difference among the three groups of patients in the intra bolus pressure(IBP),the pressure of upper esophageal sphincter(UESP)and the residual pressure of upper esophageal sphincter(UES)(P>0.05).5 According to the esophageal dynamic classification in Chicago 3.0,the proportion of IEM patients was statistically different only between the GERD group and the FH group(32.7% vs.9.0%,P<0.05),and the proportion of patients with distal esophageal spasm was not statistical differences among the three groups(12.2% vs.0.0% vs.4.5%,P=0.141),and the proportion of patients with fragmented peristalsis was not statistically different between the three groups(4.1%vs.0.0% vs.1.5%,P=0.736).6 According to the 2018 Stanford Symposium,the proportion of patients with esophagus without reserve capacity in the GERD group(49.0%)and RH group(55.0%)was higher than that in the FH group(19.4%),the difference was statistically significant(P = 0.001;GERD vs.FH group and RH vs.FH group,P<0.05)7LESP was negatively correlated with AET,reflux episodes,De Meester(r=-0.437 ?-0.418?-0.433,P<0.05).EGJ-CI was negatively correlated with AET,reflux episodes and De Meester(r =-0.506?-0.452?-0.493,P<0.05).DCI was negatively correlated with AET,reflux episodes,and De Meester(r =-0.354?-0.318?-0.356,P <0.05).Conclusions Nearly half of patients with regurgitation and heartburn symptoms are FH patients.The regurgitation symptom score and the Gerd Q have important clinical value for identifying patients with GERD,but have limited value for patients who are specifically classified as GERD,RH,and FH.Decreased anti-reflux barrier function,esophageal dysfunction,and decreased esophageal reserve capacity are the main esophageal motility problems in GERD patients;decreased esophageal contraction strength and reduced esophageal reserve capacity are the main esophageal motility problems in RH patients;esophageal motility problems in FH patients have no characteristic performance.Patients with reduced anti-reflux barrier function and reduced esophageal contraction strength have more serious regurgitation.Figure [0];Table [9];Reference [55]... |
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