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Investigation Clinical Characteristics And Detection Characteristics Of Gastroesophageal Reflux Disease With Extra-esophageal Symptoms

Posted on:2017-08-03Degree:MasterType:Thesis
Country:ChinaCandidate:H T ZhuFull Text:PDF
GTID:2334330485969944Subject:Internal Medicine
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Objective: The aim of this study is to evaluate the clinical characteristics,esophageal motility and esophageal acid exposure in gastroesophageal reflux disease(GERD)patients with extra-esophageal symptoms(EES)by High-resolution manometry(HRM),24 hours Multichannel Intraluminal Impedance-pH(MII-pH)monitoring and DX-pH monitoring.Concomitantly,compare the diagnostic consistency between MII-pH and DX-pH in patients with EES.Methods: We enrolled consecutive 87 GERD patients with EES during 2014.10-2015.12.Inclusion criteria: 1.Aged 18-70 years old.2.Patients had typical symptoms(heartburn and/or reflux),EES(paraesthesia pharynges,clearing throat,sorethroat,etc)and reflux diagnostic questionnaire score?12.3.Patients had EES without typical symptoms(heartburn and/or reflux).They were diagnosed GERD with EES by Otolaryngologists and Respiratory physicians.And their symptoms would improved over 50% after having esomeprazole 40 mg bid 14 days.4.Patients were asked to discontinue any medication that would influence esophageal motor function or proton pump inhibitor(PPI)at least 2 weeks before all the examinations.Exclusion criteria: 1.The other digestive system disease such as gastroduodenal ulcer,esophageal achalasia,pyloric obstruction,etc.The patients who had abdominal surgery.2.The patients had serious heart,brain,lung,kidney,hematopoietic system and connective tissue disease.3.Pregnancy and lactation women.4.The symptoms such as cough,paraesthesia pharynges and clearing throat were caused by clear etiology except GERD.5.Mentally disturbed.All the patients were asked to complete symptom questionnaires,reflux diagnostic questionnaire,extra-esophageal symptom questionnaire,overlapping symptoms questionnaire,reflux symptom index(RSI)and reflux finding score(RFS)questionnaires.Subsequently,they accepted the examination of HRM,MII-pH and DX-pH.HRM:Analyse the lower esophageal sphincter(LES)pressure,upper esophageal sphincter(UES)pressure,distal contractile integral(DCI)and so on.MII-pH:Analyse the DeMeester score,symptom index(SI),symptom association probability(SAP),the number of acidic reflux,the number of weakly acidic reflux and the number of non-acidic reflux.MII-pH(+):DeMeester score > 14.72 or SI ? 50%,SAP >95%.DX-pH:the RYAN score of pH<5.5 in upright position and pH<5.0 in supine position.DX-pH(+):the RYAN score?9.41 in upright position or/and the RYAN score?6.80 in supine position.The patients divided into group A(patients with typical symptoms and EES)and group B(patients with EES).Result:1 A total of 87 GERD patients with EES(group A 45,group B 42)were investigated.Of these,male 48,mean age 45.88 years,female 39,mean age 51.97 years.2 The most prevalent EES was paraesthesia pharynges(79.31%),followed by clearing throat(73.56%),sorethroat(52.87%),caries(51.72%),hoarseness(51.72%),breathless(43.68%),dysphagia(43.68%),cough(42.53%),dyspnea(42.53%)and asthma(35.63%).3 The percentages of hiatal hernia,ineffective esophageal motility,lower LESP,lower UESP and lower DCI was 6.76%,25.68%,22.97%,13.51% and 20.27%.4 The positive rate of MII-pH and DeMeester score was 22.50% and 3.75%.The percentages of abnormal acidic reflux,abnormal weakly acidic reflux and abnormal non-acidic reflux was 1.25%,17.50% and 58.57%.5 Patients with EES had a higher frequency in non-acidic reflux.The positive rate of DX-p H was 57.81%.6 The clinical feature,esophageal motility and esophageal acid exposure has no difference between group A and group B,however,RSI score in group A was higher than group B,and the daytime cough severity score in group B was higher than in group A.7 The correlation between DX-pH and MII-pH was weak.Conclusions:1The most commons EES is paraesthesia pharynges,clearing throat,sorethroat,caries,hoarseness,breathless,dysphagia,cough,dyspnea and asthma.These patients also have esophageal motility disorder.2 Non-acidic reflux may plays an important role in the occurrence of EES and laryngopharyngeal reflux.3 The correlation between DX-pH and MII-pH was weak.
Keywords/Search Tags:Gastroesophageal reflux disease, Extra-Esophageal symptom, Laryngopharyneal reflux, HRM, 24h MII-pH monitor, 24h DX-pH monitor
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