The Research On The Pathogenesis Of Refractory Gastroesophageal Reflux Disease

Objective: Application of 24 hour esophageal PH-impedance monitoring ? highresolution manometry(HRM)? anxiety and depression scores ? reflux disease questionnaire score,analysis of refractory gastroesophageal reflux disease(RGERD)to explore the pathogenesis of refractory gastroesophageal reflux disease.Methods: 84 patients with RGRED were randomly selected,methods 92 patients with gastroesophageal reflux disease(GERD)who disappeared after PPI treatment were selected as control group.All subjects were determined using 24 hour esophageal PHimpedance monitoring? high-resolution manometry(HRM)?anxiety and depression scores and reflux disease questionnaire score,Record the numbers of acid reflux ?non acid reflux ? weak acid reflux ? long acid reflux ? proximal reflux,record the parameters of upper and lower esophageal sphincter and esophageal body,record the scores of anxiety and depression ? reflux disease questionnaire and compare their difference in each group.Results: 1.Compared with gastroesophageal reflux disease group,the number of weak acid reflux increased in patients with refractory gastroesophageal reflux disease group,there was statistically significant difference(P<0.05);Compared with gastroesophageal reflux disease group,the number of long acid reflux increased in patients with refractory gastroesophageal reflux disease group,there was statistically significant difference(P<0.05);Compared with gastroesophageal reflux disease group,the number of proximal reflux increased in patients with refractory gastroesophageal reflux disease group,there was statistically significant difference(P<0.05);There was no significant difference in the number of acid reflux in patients with refractory gastroesophageal reflux disease group compared with those in gastroesophageal reflux disease group,there was no statistically significant difference(P> 0.05);There was no significant difference in the number of non acid reflux in patients with refractory gastroesophageal reflux disease group compared with those in gastroesophageal reflux disease group,there was no statistically significant difference(P> 0.05).2.Compared with gastroesophageal reflux disease group,the number of gas reflux increased in patients with refractory gastroesophageal reflux disease group,there was statistically significant difference(P<0.05);Compared with gastroesophageal reflux disease group,the number of liquid gas mixed reflux increased in patients with refractory gastroesophageal reflux disease group,there was statistically significant difference(P<0.05);There was no significant difference in the number of liquid mixed reflux in patients with refractory gastroesophageal reflux disease group compared with those in gastroesophageal reflux disease group,there was no statistically significant difference(P> 0.05).3.The length of lower esophageal sphincter in the refractory gastroesophageal reflux disease group was shorter than that in gastroesophageal reflux disease group,there was statistically significant difference(P<0.05);The pressure of lower esophageal sphincter in the refractory gastroesophageal reflux disease group was lower than that in gastroesophageal reflux disease group,there was statistically significant difference(P<0.05);4.The pressure of upper esophageal sphincter in the refractory gastroesophageal reflux disease group was lower than that in gastroesophageal reflux disease group,there was statistically significant difference(P<0.05);There was no significant difference in the length of upper esophageal sphincter in patients with refractory gastroesophageal reflux disease group compared with those in gastroesophageal reflux disease group,there was no statistically significant difference(P> 0.05).5.There was no significant difference in the number of relaxation times per second and the relaxation time of the transient lower esophageal sphincter in patients with refractory gastroesophageal reflux disease group compared with those in gastroesophageal reflux disease group,there was no statistically significant difference(P> 0.05).6.The DCI of esophageal body in the refractory gastroesophageal reflux disease group had no significant difference in comparison of gastroesophageal reflux disease group,there was no statistically significant difference(P>0.05);The PB and DL in the refractory gastroesophageal reflux disease group had no significant difference in comparison of gastroesophageal reflux disease group,there was no statistically significant difference(P>0.05).7.Compared with gastroesophageal reflux disease group,the incidence of anxiety and depression increased in patients with refractory gastroesophageal reflux disease group,there was statistically significant difference(P<0.05);Compared with gastroesophageal reflux disease group,anxiety and depression scores increased in patients with refractory gastroesophageal reflux disease group,there was statistically significant difference(P<0.05);Compared with gastroesophageal reflux disease group,reflux disease questionnaire score increased in patients with refractory gastroesophageal reflux disease group,there was statistically significant difference(P<0.05);Conclusion: 1.Compared with gastroesophageal reflux disease group,the number of weak acid reflux ? long acid reflux ? proximal reflux increased in patients with refractory gastroesophageal reflux disease group,they can lead to incomplete PPI inhibition.2.Compared with gastroesophageal reflux disease group,the number of gas reflux ? liquid gas mixed reflux increased in patients with refractory gastroesophageal reflux disease group,they can increased reflux symptom perception.3.The length of lower esophageal sphincter in the refractory gastroesophageal reflux disease group was shorter than that in gastroesophageal reflux disease group,the pressure of lower ? upper esophageal sphincter in the refractory gastroesophageal reflux disease group was lower than that in gastroesophageal reflux disease group,the length of lower esophageal sphincter ? the pressure of lower esophageal sphincter and the pressure of upper esophageal sphincter may be involved in the pathogenesis of refractory gastroesophageal reflux disease.4.Compared with gastroesophageal reflux disease group,the patients with refractory gastroesophageal reflux disease group had anxiety and depression,psychological factors may be involved in the pathogenesis of refractory gastroesophageal reflux disease.