Clinical Study On The Characteristics Of High Resolution Manometry In Primary Bile Reflux Gastritis

Objective : To explore the changes of esophageal dynamics in patients with primary bile reflux gastritis(PBRG),Showing that gastroduodenal dynamics functional changes of PBRG may affect the esophageal functional dynamics.Methods : Selecting 50 patients diagnosed with PBRG were as observation group,Control group consisted of 50 patients with gastroesophageal reflux disease(GERD),30 mixed patients(PBRG combined with GERD)and 10 healthy volunteers.According to the degree of endoscopic reflux and inflammation,50 PBRG patients were divided into two subgroups,included I degree PBRG and II+III degree PBRG.All subjects were taken high resolution manometry to analyze the esophageal dynamics indicators,included upper esophageal sphincter resting pressure(UESP),low esophageal sphincter resting pressure(LESP),changes in peristaltic and contractile function of the esophagus,etc.We observed clinical symptom scores of PBRG group,GERD group and mixed group.And observed characteristics of esophageal dynamics of different PBRG subgroups.Results:(1)The resting pressure and residual pressure of LES in PBRG group were not significantly different from those in healthy control group(P>0.05),which were significantly higher than that in GERD group and mixed group(P<0.05).The PBRG group,GERD group and mixed group had significantly lower contraction front velocity(CFV)and distal latency(DL)than the healthy control group(P<0.05).There was no significant difference among the four groups about resting pressure and residual pressure of UES,distal contractile integral and intrabolus pressure(P>0.05).The proportion of esophageal peristatic dysfunction in PBRG group,GERD group and mixed group were higher than healthy control group(P<0.05).The incidence of transient lower esophageal sphincter relaxation(TLESR)in PBRG group was lower than that in GERD group and mixed group(P<0.05),but no statistical difference compared with the healthy control group(P>0.05).(2)There was no significant difference in clinical symptom scores among the three groups of PBRG group,GERD group and mixed group(P>0.05).The symptom scores of PBRG patients in different subgroups were not statistically different(P>0.05);Symptoms scores of esophagus and stomach in PBRG group were significantly higher than those of larynx and respiratory tract(P<0.05).(3)Between the different PBRG subgroups,the higher the degree of reflux and inflammation,the slower the contraction front velocity(CFV),with a statistical difference(P<0.05).The proportion of esophageal peristaltic dysfunction gradually increased,but there was no statistically difference(P>0.05).(4)Compared with the healthy control group,the contractile front velocity(CFV),the distal latency(DL)and the proportion of esophageal peristaltic dysfunction in different PBRG subgroups were statistically different(P<0.05).The LES resting pressure and the incidence of TLESR in I degree PBRG and II+III degree PBRG were similar to healthy control group(P>0.05),however,there were significantly different between GERD group and mixed group(P<0.05).The proportion of esophageal peristaltic dysfunction in patients with I degree PBRG was lower than that in GERD group and mixed group(P<0.05),nevertheless,the proportion of esophageal peristaltic dysfunction in patients with II+III degree PBRG was similar to the GERD group and mixed group(P>0.05).Conclusions:(1)PBRG could trigger off changes in esophageal dynamic and had its characteristics.The changes of gastroduodenal function dynamics in patients with PBRG may lead to bile-related gastroesophageal reflux by causing esophageal motility disorders and peristaltic dysfunction,resulting in reduced clearance capacity,indicating that PBRG may often be complicated by gastroesophageal reflux.(2)Abnormal peristaltic contraction of esophageal body in patients with different degrees of PBRG increased significantly,while`the pattern of abnormal peristaltic contraction of esophageal body in moderate-severe PBRG were close to that of GERD.(3)The esophageal and gastric symptoms were the main symptoms in PBRG patients,and there was no significant difference from the clinical symptoms of GERD patients,but the clinical symptoms were not consistent with the degree of endoscopic bile reflux and gastric mucosal inflammation.