| Objectives The esophageal motility,reflux and psychosocial characteristics of nonerosive reflux disease(NERD),reflux hypersensitive(RH)and functional heartburn(FH)were comprehensively analyzed by high resolution esophageal manometry(HRM),24-hour esophageal multichannel intracavitary impedance p H monitoring(MII-p H)and psychological status investigation in patients with endoscopic negative heartburn,so as to provide theoretical basis for individualized treatment.Methods A total of 66 patients with typical reflux-related symptoms such as heartburn and negative endoscopy were included in the Department of Gastroenterology,Hebei General Hospital from January 2019 to December 2020.All participants filled in selfrating anxiety scale(SAS)and self-rating depression scale(SDS),and examined by HRM and 24 h MII-p H.According to the consensus diagnostic criteria of Rome IV and Lyon,and according to the results of 24 h MII-p H,the patients were divided into three groups: NERD,RH and FH.According to the results of SAS score,SDS score,HRM and 24 h MII-p H,the differences of esophageal motility parameters,reflux indexes and mental and psychological characteristics among NERD group,RH group and FH group were analyzed.Results 1 There was no significant difference in gender composition and BMI among the three groups.The age of NERD group(52.4±10.1)and FH group(55.0±11.3)was higher than that of RH group(44.3g±14.8),and the difference was statistically significant.2There was no significant difference in SDS score among the three groups.The SAS score of FH group(46.7±8.3)was significantly higher than that of NERD group(39.7±8.9),the difference was statistically significant(P<0.05).More than half of the FH group(62.5%)and the RH group(52.2%)suffered from anxiety or depression,which was significantly higher than that of the NERD group(21.1%),but there was only a statistical difference between the FH group and the NERD group(P<0.05).3 The DCI of FH group[(2350.0±1191.7)mm Hg/cm·s] was significantly higher than that of NERD group[(1537.4±982.2)mm Hg/cm·s] and RH group [(1610.5±844.7)mm Hg/ cm·s].Compared with FH group,the DL of NERD group [6.6(6.1,8.0)s vs.7.4(6.9,8.9)s] was significantly prolonged(P<0.05),and the proportion of patients with MRS-DCI enhancement(79.2% vs.42.1%)was significantly decreased(P<0.05),LESP [(16.9±8.8)mm Hg vs.(10.7±4.4)mm Hg] and EGJ-CI [27.1(11.8,55.6)mm Hg/cm vs.13.2(2.6,23.2)mm Hg/cm] decreased significantly(P<0.05).There was no significant difference in the proportion of patients with DL,MRS-DCI enhancement,LESP and EGJ-CI between the RH group and the other two groups(P>0.05).There was no significant difference in IBP,4s-IRP and the proportion of patients with ineffective esophageal motility among the three groups(P>0.05).4Compared with RH and FH,in NERD group,De Meester score[5.6(2.4,13.7)points vs.6.4(1.5,9.9)points vs.32.0(28.7,39.3)points],acid reflux times [13(8,33)times vs.11(3,21)times vs.30(19,50)times] were significantly higher(P<0.05).There was no significant difference in the times of weak acid reflux and non-acid reflux among the three groups(P>0.05).The proportion of acid reflux in NERD group,RH group and FH group was respectively 73.3% vs.54.0% vs.45.4%,The proportion of weak acid reflux was respectively 23.1% vs.38.0% vs.48.4%,The proportion of non-acid reflux was respectively 3.6% vs.8.0% vs.6.2%.There was statistical difference in the proportion of various reflux among the three groups(P<0.05),in NERD and RH groups,acid reflux was dominant,while in FH group,weak acid reflux was dominant,and the proportion of weak acid reflux in RH and FH groups was significantly higher than that in NERD.Compared with FH group,the number of proximal reflux in NERD group and RH group [9(5,17)times vs.22(13,36)times vs.17(9,34)times] was significantly increased(P<0.05),and the proportion of proximal reflux in NERD group and RH group [(37.0±14.0)% vs.(48.3±14.5)% vs.(46.1±14.7)%] was significantly increased(P<0.05).Compared with RH group and FH group,the average acid scavenging time of NERD group [40(25,70)s vs.48(35,81)s vs.108(84,137)s] was significantly longer(P<0.05),while distal MNBI[2149.0(1670.9,2427.8)Ω vs.2316.3(1805.2,2495.8)Ω vs.1511.4(854.7,1751.3)Ω]was significantly decreased(P<0.05).There was no significant difference in proximal MNBI among the three groups(P>0.05).5 AET was negatively correlated with LESP,DCI and EGJ-CI,and positively correlated with average acid scavenging time.De Meester score was negatively correlated with LESP,DCI and EGJ-CI.The total number of reflux was negatively correlated with LESP,DCI and EGJ-CI.The number of proximal reflux was negatively correlated with LESP,DCI and EGJ-CI.Distal MNBI was negatively correlated with AET,total number of reflux,acid reflux times,proximal reflux times and proximal acid reflux times.Conclusions 1 NERD patients have no characteristic psychological manifestations;the characteristics of esophageal motility are as follows: anti-reflux barrier function,esophageal body motor function and reserve function are significantly decreased;the characteristics of reflux reflux are as follows: the proportion of acid reflux is the largest,the proportion of proximal reflux is increased,esophageal clearance ability is decreased,and distal esophageal mucosal injury is severe.2 The onset age of RH patients is younger,and half of the patients are accompanied with anxiety or depression;the esophageal motility is characterized by decreased esophageal body motor function;the characteristics of reflux reflux are as follows: the proportion of acid reflux is the largest,but the proportion of weak acid reflux is relatively high,and the proportion of proximal reflux is increased.3 More than half of the patients in FH group had anxiety or depression,there was no characteristic manifestation of esophageal motility;the characteristics of reflux reflux is: the proportion of weak acid reflux is the largest;4 The decrease of anti-reflux barrier function and esophageal body peristaltic function can increase reflux;acid reflux is an important factor of distal esophageal mucosal injury;the decrease of acid scavenging ability is an important factor to aggravate acid reflux.Figure 0;Table 11;Reference 169... |
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