| Abstract Ⅰ Evaluation of Esophageal Mucosal Barrier Function in NERD by Multichannel Intraluminal Impedance-pH Monitoring Combined with Acid Perfusion TestAims:To investigate the acid-induced dynamic changes in esophageal impedance and its correlation with reflux symptoms and dilated intercellular space (DIS) in NERD patients by acid perfusion test combined with multichannel intraluminal impedance and pH monitoring (MII-pH).Subjects and Methods:From September 2013 to July 2014, a total of 35 NERD patients from China-Japan Friendship Hospital and 20 healthy controls were subjected to 24 h MII-pH monitoring, acid perfusion, and gastroendoscopy. Two endoscopic mucosal biopsies were taken from the anterior and posterior walls at 2 cm above the dentate line of the esophagus. Intercellular spaces (ICS) in the esophageal epithelia were measured by software.Results:(1) NERD patients had lower impedance baseline of distal esophagus (2998±701 vs.3880±1054 Ω, P<0.01), lower impedance recovery rate after acid perfusion (30.1 ± 14.0 Ω/min vs.53.0±14.5 Ω/min, P<0.01). (2) A significant correlation was observed between impedance baseline and impedance recovery rate (r=0.71, P<0.01) and a significant negative correlation was observed between impedance baseline and acid exposure time (AET) (r=-0.58, P<0.01) as well as impedance recovery rate and AET (r=-0.61, P<0.01). (3) The NERD patients with positive response in acid perfusion test showed lower baseline impedance (2755±680 Ω vs.3411±536 Ω, P< 0.01) and lower impedance recovery rate (24.9±13.3 Ω/min vs.33.7±10.3 Ω/min, P<0.05) than those felt no pain during perfusion. (4) Wider ICS (1.03±20 μm vs.0.66±0.14 μm, P<0.01) was shown in NERD patients than the controls. (5) A significant correlation was observed between ICS and heartburn symptom score and total symptom score (r=0.42, P<0.05; r=0.59, P<0.05).Conclusions:Impaired mucosal integrity may be caused by repeated reflux-induced injury with slow mucosal recovery in NERD patients. The changes in esophageal baseline impedance can partially reflect the level of esophageal mucosal integrity impairment.Abstract Ⅱ Microstructural Changes of Esophageal Mucosa and Expression of Protease Activated Receptor-2 in Patients with Non-erosive Reflux DiseaseAims:To investigate microstructural changes of esophageal mucosa by endoscopic mucosal biopsy in NERD patients and epithelial expression of protease activated receptor-2 (PAR-2) by immunohistochemistry, and analyze its correlation with DIS.Subjects and Methods:From August 2013 to July 2014, a total of 59 NERD patients from China-Japan Friendship Hospital and 20 healthy controls were subjected to gastroendoscopy. Two endoscopic mucosal biopsies were taken from the anterior and posterior walls at 2 cm above the dentate line of the esophagus. After Hematoxylin and Eosin (HE) staining, microstructural changes in the esophageal mucosa were observed, including basal cell hyperplasia (BCH), epithelial papillary elongation (PE), inflammatory cell infiltration, epithelial cell ballooning degeneration and dilated intercellular space (DIS). The expression of PAR-2 in epithelial tissue was detected by immunohistochemistry.Results:(1) In NERD group and HS group, the detection rate of basal cell hyperplasia was 84.7% and 30.0%, respectively. The detection rate of epithelial papillary elongation were 49.2% and 15.0%, epithelial cell ballooning degeneration were 76.3% and 5.0% and the infiltration of inflammatory cells were 35.6% and 10.0%. (2) PAR-2 was widely expressed in esophageal epithelial cells in NERD group. The intercellular spaces of esophageal epithelia in NERD patients were widened significantly (1.00±0.21 μm vs.0.67±0.13μm, P<0.01) and the expression of PAR-2 was significantly higher than that of the control group (6.97±1.73 vs.1.45±0.99). (3) A positive correlation was observed between DIS and PAR-2 (r= 0.65,P<0.01).Conclusions:The esophageal mucosa in NERD patients had a series of microstructural changes. The PAR-2 mediated pathway may be involved in the pathogenesis of NERD through the redistribution of the tight junction proteins which may cause DIS.Abstract Ⅲ Investigation of Symptom Spectrum and Possible Relative Factors in Patients with Non-erosive Reflux Disease and Reflux EsophagitisAims:To investigate the demographics, symptom spectrum, diet, quality of life and psychological status in patients with NERD and RE and compare the clinical characteristics between the two groups for the further study of the pathogenesis and effective treatment of GERD.Subjects and Methods:105 cases of GERD patients were enrolled in the study, including 60 cases of NERD patients (18 males,42 females, mean age 44.1 ± 13.4 years),45 cases of RE patients (22 males,23 females, mean age 46.5±9.9 years). To analyse the demographics, clinical features, diet and lifestyle, quality of life, psychological status in patients with NERD and RE by questionnaires.Results:(1) The regurgitation symptom score and the rate of regurgitation symptoms in NERD group were lower than RE group [0 (0,2) vs.2.0 (0,3.0), P<0.05; 45.0% vs. 64.4%, P<0.05]. Reflux symptom score had no significant difference between two groups [8.0 (6.0,11.0) vs.10.0 (7.0,13.0), P>0.05]. (2) The rate of toothache and dental caries in NERD was higher than RE group (41.7% vs.8.3%, P<0.01; 55.0% vs.8.3%, P<0.01), and the secondary symptom score was significantly higher in NERD group [4.0 (2.0,5.0) vs.2.0 (1.0,5.0), P<0.05]. (3) The top five diet causing reflux symptoms were:dairy products, spicy food, onion or leek, sweet food and yogurt. The top five factors causing reflux symptoms besides diet were:bad mood, eating too full, cold, postprandial stoop and poor sleep. (4) NERD patients with psychological abnormality had significantly higher reflux symptom score than those with no psychological abnormality (10.9±4.7 vs.8.3±2.8, P<0.05). (5) Anxiety and depression score was correlated with reflux symptom score in NERD (r=0.42, P<0.01; r=0.29, P<0.05), and reflux symptom score was significantly correlated with GERD-HRQL (r=0.49, P<0.01).Conclusions:The proportion of women was higher and regurgitation symptom was less serious in NERD group than RE group, but reflux symptom score had no significant difference between the two groups. Diet and lifestyle played a certain role in the occurrence of NERD symptoms. Reflux symptoms were significantly correlated with quality of life and psychological status in NERD patients. |
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