A Research About The Relation Between The Different Grade Reflux Esophagitis And Esophageal Motility Dysfunction

Background:Reflux esophagitis is caused by many factors of esophageal mucosainjury.The mechanism of resistance mainly is esophageal refluxmechanism weakens and reflux content to esophageal mucous membraneattack enhanced.The former include LES pressure change, transient loweresophageal sphincter relaxation(TLESR), esophageal expurgationdysfunction and antireflux esophageal mucosa barrier dysfunction.LESchange is an important mechanism for the cause of reflux esophagitis.Atpresent, the diagnosis of RE, there are a lot of clinical auxiliarymethod.Including endoscopy and esophageal pressure,24hours pHmonitoring, esophageal24hour bile determination,esophagealbarium:X-ray and nuclide examination,proton pump inhibitors diagnostictreatment method,in which endoscopy are the important inspection. By endoscopy can determine the severity of RE and presence ofcomplications, and combining with biopsy can differentiated from othercauses of esophagitis, esophageal lesions (such as esophagealcancer).Esophageal pressure is the gold standard for evaluation ofesophageal motor function.It can be used to have difficulty swallowing,heartburn, or chest pain and other clinical manifestations of the diagnosis ofesophageal dynamic disorder.In patients with RE,esophageal pressure can getLES resting pressure, residual pressure, LES esophageal peristalsisfunction,help assess the antireflux barrier function, esophageal body clearanceability and other antireflux mechanism whether abnormal,lay a foundation forclinical study of the pathogenesis of RE.But because the traditionalesophageal pressure measuring method is time-consuming, laborious,thesensitivity and specificity are limited, patients’ resistance is poorer,resultsanalysis need experienced clinicians and other shortcomings,so has not yet been widely applied to clinical.With the improvement of science technologyand knowledge, esophageal pressure technology has been changed from thetraditional3~8passages of esophageal pressure method to36channels HRMof pressure sensor, the pressure measuring method is time-saving,labor-saving,simple operation,high sensitivity and specificity,objective analysis,etc.Butbecause it is used only a short four years time,by the domestic understandingalso just two years,therefore,its clinical application was still in the stage ofresearch.It has not yet have using HRM to study the correlation betweenreflux esophagitis and disfunction of esophagus,mucosa damage degree anddysfunction.Research purposes:Main purpose of this study use HRM to measure different gradereflux esophagitis patients, evaluation esophageal LES length,residualpressure,esophageal amplitude, contraction front velocity and other data.At last,use statistical methods to analyze esophageal dynamicdysfunction of different grade reflux esophagitis.To study thepathogenesis of reflux esophagitis provides the basis, for the clinicaltreatment of reflux esophagitis play a important role.Materials and methods:Patients between Oct2010and Oct2012who were diagnosedreflux esophagitis according to endoscopy were selected,18-60yearsold,men and women not limited.Achalasia,Diffuse esophagealspasm,esophageal hyperpressure and other functional diseases,history ofgastrointestinal surgery,serious diseases in heart,lungs, liver,kidney,nose,the digestive tract tumor diseases,diabetes,scleroderma,neurologicaldisease and other movement function obstacle disease were excluded.According to the Los Angeles classification,the patients were dividedinto four group: A group(grade A):mucosa damage limited to fold that break5mm or less;B groups(grade B): at least One mucosal break morethan5mm-long that does not extend between the tops of two mucosalfolds; C group(grade C): mucosal break that is continuous but thatinvolves less than75%of the circumference; D group(grade D): mucosalbreak that involves at least75%of the esophageal circumference.Patients diagnosed chronic gastritis-not atrophy with no currentsymptoms and other complications under gastroscope were selected ascontrol. Gastroscopy postoperative no smoking, alcohol,high fat diet,coffee and drugs cause esophageal dynamics change,such as Prokineticdrugs,Calcium antagonists, Macrolides24hours.Use ManoScan360°solid-state high-resolution manometry to measure esophagealpressure. evaluation esophageal LES length, residual pressure, the LESon the edge of3,7,11cm amplitude, contraction front velocity and otherdata. At last, use statistical methods to analyze esophageal dynamic dysfunction of different grade reflux esophagitis.Results:(1)LES resting pressure：Using the method of nonparametric ranksum test,the control group, group A,group B and group C,respectivelycompared with group D(P<0.005),compared the control group with groupB,group C (P<0.005),compared the other two two groups(P>0.005);(2)LES length: Compared the control group with D group,(P<0.005);(3) The LES3cm amplitude: First carries on the analysis of variancetest, then use Bonferroni test two two compare; result show that controlgroup respectively compared with group B,group C and group D wasstatistically significant(P<0.05),group A respectively compared withgroup C,group D and group B compared with group D(P<0.05),comparedthe rest groups had no statistical significance;(4) the LES7cm amplitude: D group with the control group,group A,group B and group C compared (P<0.005),group A and group B,groupA and group C,group B compared with group C(P<0.005;(5) The LES11cm amplitude: draw the control group,group A,groupB and group C,respectively compared with group D(P<0.005,comparedthe control group with group B(P<0.005),compared two groups(P>0.005);(6)CFV: Comparison between two groups were no statisticalsignificance.Conclusion:Different grade reflux esophagitis exist esophageal motilitydysfunction.