| Part1Research of risk factors for Refractory gastroesophageal reflux disease BackgroundGastroesophageal reflux disease (GERD) is a condition that develops when reflux of stomach contents causes troublesome symptoms and/or complications.GERD is a very common chronic disease, and GERD patients not only have typical symptoms of heartburn and regurgitation, but also have extra-esophageal disorders. Refractory GERD is patients who fail PPI treatment, the clinical condition is very complicated, and there is no standard diagnosis yet.ObjectiveThis study is based on the research of patients’result of24-h ambulatory esophageal impedance-pH monitoring and clinical information, to compare the reflux condition between refractory GERD and non-GERD; in order to provide evidence for the pre-diagnosis of gastroesophageal reflux disease.MethodsDuring October2008and December2012, patients complaining of suspected reflux symptoms or extra-esophageal manifestations were treated in Gastroenterology Department in Zhong-Shan Hospital. The patients’age, sex, height, weight, and the result from endoscopy were recorded. All patients were underwent MMS ORION Ohmega24-h ambulatory esophageal impedance-pH. The definition of refractory GERD is patients with gastro-esophageal reflux disease (GERD) who are not responding to or<50%improvement in the chief complaint after giving once daily for at least4weeks proton pump inhibitors (PPIs). Patients with gastro-esophageal reflux disease (GERD) who are responding to or>50%improvement in the chief complaint after giving once daily for at least4weeks proton pump inhibitors (PPIs) are not refractory GERD. Patients with normal results from endoscopy or24-h ambulatory esophageal impedance-pH are not GERD. Using SPSS17.0to compare the basic conditions and reflux characteristics between GERD, and refractory GERD patients. Results1、There are total97patients included, excluding23not GERD patients, there are54refractory GERD, and20not refractory GERD. There are32male,42female, and the average age is47.6year-old, BMI22.2kg/m2. There is no statistic difference between each groups.2、Refractory GERD has more acid reflux than not refractory GERD, but there is statistic meaning. There is no difference in total reflux. Refractory GERD has higher DeMeester score (p=0.032), and more acid reflux longer than5min (p=0.008) than not refractory GERD, and there is statistic meaning.3、After logistic regression analysis, we found that Refractory GERD has positive correlation with total acid reflux longer than5min, and NERD, and there is significant difference. When one acid reflux longer than5min happens, the risk of refractory GERD is increasing36%. The risk of NERD who is refractory GERD is4.54times than RE.4、The reflux characteristics of different GERD:The total proximal reflux of NERD is more than RE and Barrett, and the percentage of proximal reflux is way more than RE and Barrett.Conclusions1、 More acid reflux longer than5min and NERD are the independent risk factors for diagnosis of refractory GERD.2、 NERD has higher tendency to become refractory GERD than RE. The increase of proximal reflux percentage of NERD may have relations with its response to PPI. Part2Research of the motility of Gastroesophageal reflux disease patients under high resolution esophageal manometryBackgroundGastroesophageal reflux disease, GERD, is a very common gastroeneterology disease, and its incidence rate is ascending. The increasing exposure of esophagus to acid plays a important role in the causes of GERD. In to addition to acid reflux, esophageal motility disorder, such as incomplete or lacking of esophageal body peristalsis is also an important cause of GERD. Esophageal motility disorders are the basis of the incidence.ObjectiveThis study is based on the research of patients’ result of HRM and clinical information, to compare the motility between refractory GERD, not refractory GERD, and normal people; in order to play a guiding role for the clinical treatment of GERD patients.MethodsDuring December2011and March2013, patients complaining of suspected reflux symptoms or extra-esophageal manifestations were treated in Gastroenterology Department in Zhong-Shan Hospital. The patients’age, sex, height, weight, and the result from endoscopy and24-h ambulatory esophageal impedance-pH were recorded. All patients were underwent MMS HRM. Every HRM examination contained5min resting pressure, and10water swallows. Parameters of the esophagogastric junctions (the length of LES, LES resting pressure, LES relaxation parameters,4sIRP), and parameters of esophagus body motility (DCI, CFV) were analyzed. There are9healthy volunteers underwent HRM are recorded.The software SPSS17.0was used to compare the motility between each group.Results1、There are total49people included,27GERD patients (18not refractory GERD,9refractory GERD),13functional heartburns, and9healthy volunteers. There are20male,29female, and the average age is50year-old, BMI23.1kg/m2. The average age of heartburn partients is51year-old, BMI22.2kg/m2. Healthy vlounteers’ average age is49.2year-pld, BMI24.9kg/m2.The average age of refractory GERD patients is43.8year-old, BMI23.6kg/m2. Not refractory GERD patients average age is53.3year-pld, BMI22.0kg/m2. There is no statistic difference between each groups.2、Index of esophagus motility2.1esophageal motility result of healthy volunteersLES length is2.8±0.4, LES resting pressure is16(5,19.5), LES relaxation rate is60(23.5,73), DCI is387(150.5,969), and CFV is5.2±1.8,4sIRP为3(-3.5,6).2.2esophageal motility result of heartburn patientsLES length is2.2±0.57, LES resting pressure is13(6.5,19.5), LES relaxation rate is44.5(25.5,65.75), DCI is315(150.5,589.5), CFV is5.9±4.4,4sIRP is3.5(1.5,8.25).2.3esophageal motility result of refractory GERD and not refractory GERD(1) LES length:refractory GERD is2.7±0.9, not refractory GERD is3.0±1.0, and there is no statistic difference between each groups;(2) LES resting pressure:refractory GERD is14(10,24.5), not refractory GERD is9(5.75,13.25), and there is no statistic difference between each groups;(3) LES relaxation rate:refractory GERD is68(46.5,86), not refractory GERD is53.5(32,69), and there is no statistic difference between each groups;(4) DCI:refractory GERD is215(25,350.50, not refractory GERD is158.5(53.3,554.8), and there is no statistic difference between each groups(5)CVF:refractory GERD is5.1±1.8, not refractory GERD is3.91±1, and there is signicant meaning (p=0.046);(6)4sIRP:refractory GERD is3(-.45,9.5), not refractory GERD is2(-1.5,4.13), and there is no statistic difference between each groups;(7) When using Chicago classification in high resolution manometry to evaluate esophagus motility in each group, we found that the percentage of defining as deficiency and weak esophageal peristalsis had higher rate.ConclusionsGERD patients have specific abnormal esophageal pressure. CVF is higher in refractory GERD. Chicago classification in high resolution manometry may not be applicable to Chinese people, and there may be certain diversity in esophagus motility between eastern and western people. |
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