| Objective: Explore the interaction of esophageal function and gastric function inthe pathogenesis of gastroesophageal reflux disease(GERD) by analysis on thecharacteristics of50GERD patients’ esophageal motility change and gastricmyoelectric activity by combined test of esophageal manometry and EGG, thus tocontribute to the clinical diagnosis and treatment.Methods:50GERD patients (including17cases of RE patients and33cases ofNERD patient) and15controlled patients were selected into3groups (RE group,NERD group and controlled group).. Esophageal motility informations including LESpressure and changes in esophageal motility parameters of these cases were detected byXDJ-S8-type Detector and compared while surface EGG monitoring was operated usingnew EGEG-8D-type eight-guide smart gastrointestinal electrical plotter both before andafter a standard meal and the data was collected and compared.Results:1. Average LES resting pressure and LES relaxation rate of RE group, the NERD groupand controlled group were9.65mmHg,10.69mmHg,21.3mmHg and62.45mmHg,61.72mmHg,82.04mmHg respectively. LES resting pressure and average LESrelaxation rate of RE group, the NERD group and controlled group had significantlydifferences compared with controlled group (P<0.05). LES residual pressures in3groups had no significant difference（P＜0.05）.2. Average, far end systolic pressure of RE group and NERD group were40.01mmHgand60.78mmHg respectively, which had no significant difference (P<0.05); and thedatum were significantly different comparing to controlled group (74.65mmHg) (P<0.05). No difference showed among the groups when considering proximal systolicpressure data.3. Average remote contract duration of RE group, NERD group and controlled groupwere5.44s,6.85s and5.59s respectively, and data of NERD group was significantlydifferent comparing to datum of RE group and controlled group (P<0.05). Averageproximal contraction duration of RE, NERD group and controlled group were4.81s,6.76s and4.57s, and data of NERD group was significantly different comparing todatum of RE group and controlled group (P<0.05).4. Average peristaltic wave conduction velocity of RE group, NERD group andcontrolled group were2.60s,1.48s and2.45s, and data of NERD group wassignificantly different comparing to datum of RE group and controlled group (P<0.05).5. Average waveform frequency before meal of RE group, NERD group and controlledgroup were2.95cpm,2.98cpm and2.98cpm, which had no difference (P>0.05). Averagewaveform frequency after meal of RE group, the NERD group and controlled groupwere2.06cpm,2.13cpm and2.13cpm. Differences showed between preprandial andpostprandial waveform frequency in all3groups (P<0.05). Waveform frequency of REand NERD group had significant difference comparing to controlled group (P<0.05).6. Average normal slow wave percentage of RE group, NERD group and controlledgroup were77.35%,76.02%and77.35%respectively, and datum of NERD group andRE group were significantly different comparing to data of controlled group (P<0.05).Average normal slow wave percentages after meal of RE group, NERD group andcontrolled group were68.86%,67.90%and84.08%respectively. Datum of NERDgroup and RE group were significantly different comparing to data of controlled group(P<0.05), and differences showed before and after meal in RE group and NERD group(P<0.05).7. After dinner/meal before power ratio of RE group, NERD group and controlled groupwere0.93,0.95and1.27respectively, and datum of NERD group and RE group weresignificantly different comparing to data of controlled group (P<0.05).8. Gastric electric rhythm disorder percentages before meal of RE group, NERD groupand controlled group were35.29%,21.21%and3.56%respectively, having nosignificant difference (P<0.05). Gastric electric rhythm disorder percentages after mealof RE group, NERD group and controlled group were58.82%,45.45%and4.23%respectively, significant differences showed among3groups (P<0.05). the three groups of patients with gastric electric rhythm disorder percentage difference before andafter the meal also statistically significant (P<0.05).9. The patients were divided into normal gastric motility group and abnormal gastricmotility group, according to the postprandial/Preprandial Power ratio. The LESP andthe distal esophageal body contraction pressure were compared and the correlation wasobserved between two groups.The results of LESP in Two groups were9.58±1.24mmHg (n=28) and18.8±2.23mmHg (n=22), respectively,and there was a significantdifference between them (P <0.05). the LESP and gastric motility disorder weresignificantly correlated (r=0.52, P <0.05). The results of distal esophageal bodycontraction pressure in two groups were38.46±2.85mmHg (n=31) and55.42±4.32mmHg (n=19), respectively, and there was a significant difference between them (P <0.05). the distal esophagus body contraction pressure and gastric motility disorder alsocorrelated (r=0.44, P <0.05)10. The patients were divided into normal gastric electrical frequency group andabnormal gastric electrical frequency group, according to the dominant frequency. TheLESP and the Distal esophageal body contraction were compared and the correlationwas observed between two groups.The results of LESP in Two groups were8.28±2.01mmHg (n=32) and20.1±1.12mmHg (n=18), respectively, and there was a significantdifference between them (P <0.05). The LESP and gastric electrical frequency weresignificantly correlated (r=0.52, P <0.05). The results of distal esophageal bodycontraction pressure in Two groups were55.58±1.85mmHg (n=24) and60.34±3.28mmHg (n=26), respectively, and there was no significant difference between them (P＞0.05). The distal esophagus body contraction pressure and gastric motility disorder hadno significant correlation (r=0.13, P>0.05).Conclusion: Esophageal body movement dysfunction and lower LES pressuremay be the most important pathogenesis mechanism of GERD. Gastric motilitydisorders also plays a role in the pathogenesis of GERD, especially in the patientswith RE. The incidence of GERD may also be the synergistic effect of the abnormalesophageal function and the abnormal gastric function. Abnormal gastric electricalfrequency may affect the function of LES, gastric motility disorder may lead to LESand esophageal peristalsis function. The combine with esophageal manometry andElectrogastrogram has necessity and feasibility in the diagnosis of GERD. |
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