Multiple Factor Analysis On The Pathogenesis Of Non-erosive Reflux Disease In 120 Cases

Objective: To investigate the different pathogenesis between non-erosive reflux disease (NERD) and reflux esophagitis (RE).Methods: 239 patients with regurgitation or heartburn from 1998-2005 were assessed in this study. Patients with damaged esophageal mucosa valuated by endoscopy were regarded as the RE group, others as the NERD group. The clinical feature and whether combined with H.pylori infection in both groups were reviewed and all patients underwent esophageal manometry and 24hours esophageal pH monitor. According to the results of 24hours esophageal pH monitor and symptom index (SI), the NERD groups were divided into 3 groups.Results: 1.NERD and RE groups comparison:(1)Baseline characteristic comparison: There is no big difference between these two groups in patient age, weight, height, the body weight index(BMI) and Hp infection (P>0.05). NERD and RE group in sex constitution , the symptom of outside the esophagus formation rate, the tobacco and liquor hobby and the hiatus esophageus hernia example number comparison has the difference: The morbidity of RE group male are more than female, the NERD group female is taken bad many, the two group have statistics significance (P<0.05); Among RE group patients the time smoking and drinking patients is less than that in the NERD group, compared with has statistics significance (P<0.05); The RE combination and hiatus hernia (HH) patients is obviously more than the NERD group, the two have statistics significance (P<0.05).(2)Symptom comparison: the RE group to have the sour regurgitation ,the heartburn and the food regurgitation symptom example number compares the NERD group to be few, has statistics significance (P<0.05), comparison of retrosternal ache symptom example number of the two groups are approximate.( 3) Esophageal manometry: LES pressure, UES pressure, the esophagus body department near section creeping motion wave ridge value, and the conduction velocity, the stomach intrinsic pressure and the barrier press do not have statistics significance (P>0.05). In esophagus body department, far section creeping motion wave ridge value existence statistics significance (P<0.05).Esophagus pathology wriggles the RE group 43 examples, the existence loses wriggles 15 examples, the NERD group 27 examples, the existence loses the creeping motion 9 examples, the two comparison existence statistics significance (P<0.05)(.4)24hours esophageal pH monitor :Two group of patients both have the pathological regurgitation, the RE group was higher than the NERD group. 24h the esophagus pH monitoring result compares of two groups to set up the position pH<4 time percentage, the longest sour regurgitation time, the pH<4 total time, the pH<4 percentage, position pH horizontal, the sour regurgitation area, the sour regurgitation index comparison difference not to have the significance (P>0.05). NERD the group decubitus pH<4 time percentage is lower than the RE group (P<0.05, difference has significance), NERD group decubitus average pH is lower than the RE group (P<0.05, difference has significance). NERD group De-meester normals is 22.8825 equally, the normal reference value 14.72 elevate (P<0.05, difference has significance), RE group De-meester normals is 39.1282 equally, higher than the normal reference value 14.72 elevate (P<0.05, difference has significance), the two comparison existence statistics significance (P<0.05).2.Three hypotypes of NERD comparison:(1)Baseline characteristics of the patients comparison: compare the three hypotypes patients age, sex, height and Hp infection several items of material to compare the non-significance difference (P>0.05), weight and body weight index(BMI) existence significance difference (P<0.05), 1, 2 group and 1, 3 groups compare the body weight and the body weight index have the significance difference (P<0.05). The acid sensitive esophagus and the functionality heartburn body weight and the body weight index is lower than the exceptionally sour regurgitation group.(2) The symptoms comparison the NERD three hypotypes comparison counter-acid, the heartburn, in the retrosternal pain and the counter-food four symptoms the retrosternal painful symptom difference has the significance (P<0.01), the counter-sour symptom difference existence difference, has statistics significance (P<0.05), the exceptionally sour regurgitation and the functionality heartburn two group of counter-sour symptom existence difference, has statistics significance (P<0.01), does not have the difference with the functionality heartburn comparison (P>0.05); The exceptionally sour regurgitation and the acid sensitive esophagus two groups compare the retrosternal painful symptom not to have the difference (P>0.05); Other 22 comparisons do not have the difference (P>0.05).(3)Esophageal manometry result: to compare NERD three hypotype esophagus UESP, LESP, esophagus near section, the center-section, the far section peak value and the stomach intrinsic pressure, the barrier pressure compares the difference not to have the significance (P>0.05). After 22 quite unusual sour regurgitation group stomach intrinsic pressure is higher than both, has statistics significance with the acid sensitive esophagus comparison difference (P<0.05). Sour after the exceptionally regurgitation group esophagus body department far section peak value is higher than obviously both, have statistics significance with the functionality heartburn comparison difference (P<0.05).(4)24h the esophagus pH monitoring result is quite unusual the sour regurgitation exceptionally sour regurgitation group and the acid sensitive esophagus 2 groups with the functionality heartburn group in the acid regurgitation target the majority of existence significance difference (P<0.05), but in the average pH level, position pH horizontal aspect and functionality heartburn has not obvious difference (P>0.05).Conclusion: 1.The non-erosive reflux disease is different from reflux esophagitis; 2.The main pathogenic difference is that reflux time and defense effect in NERD than that of RE. 3. There is significant difference in quantity of acid reflux and motility dysfunction of distal part of esophagus among three types of NRED. 4. NERD is related to age, sex, height, weight, BMI,outside esophagus symptom, as well as esophageal hiatal hernia, which are different from RE.5. Individual and comprehensive treatment should be taken into consideration according to different NRED pathogenic mechanism.