Correlation Of The Gastroesophageal Flap Valve Grade By Endoscopy With Gastroesophageal Reflux Disease And Correlative Factors Of The Gastroesophageal Flap Valve

Background The prevalence of gastroesophageal reflux disease(GERD)has risen in recent years,it has attracted a lot of attention.Gastroesophageal flap valve(GEFV)located in the gastroesophageal junction is one mechanism of the anti-reflux barrier,it was confirmed by Hill et al.GEFV was graded from I to IV using Hill's classification.Grade I and II regarded as normal flap valve,grade III and IV are abnormal flap valve.The correlation of gastroesophageal flap valve with reflux esophagitis(RE)caused widespread concern,but the research on the correlation between gastroesophageal flap valve and non-erosive gastroesophageal reflux disease(non-erosive reflux disease NERD)is steel rare;besides,the correlative factors of the gastroesophageal flap valve are not completely clear.Objective The aim of the present study was to analysis the association between GEFV and GERD?NERD?RE in patients who had undergone endoscopy.Meanwhile,we try to investigate the potential correlative factors of gastroesophageal flap valve.Methods Among patients undergoing endoscopic examination at The Affiliated Hospital of Qingdao University between December 2015 and September 2016,a total number of 187 patients with various grades of gastroesophageal flap valve were selected.Patients with Peptic ulcer?esophageal cancer?gastric cancer?esophageal varices? upper gastrointestinal surgery ? severe hepatic and renal dysfunction ? severe cardiovascular disease and various causes of pyloric obstruction were excluded.Patients with esophagitis were graded according to the Los Angeles classification.All patients included in this study were assessed with the RDQ scale and fill in the questionnaire.The height and weight of the subjects were measured,body mass index(BMI)was calculated.GERD diagnosed by both endoscopy and RDQ questionnaire,GERD patients without esophageal mucosa damage diagnose NERD.Analyze the correlation between GEFV and GERD ? NERD ? RE;Meanwhile,investigate the potential correlative factors of gastroesophageal flap valve.Results In the present study,the incidence of RE among different groups with grade I to IV valve were 7.5%,14.0%,32.2%,48.4%.The incidence of esophagitis in patients with abnormal GEFV was 37.8%,which was significantly higher than that in patients with normal GEFV(11.3%)(P <0.05).A total of 5 cases with grade C and D Esophagitis were all found among the patients with abnormal GEFV.The incidence of NERD among different groups with grade I to IV valve were 2.5%,15.8%,22.0%,22.6%,the incidence of NERD in the abnormal GEFV group(22.2%)was significantly higher than that in the normal GEFV group 10.31%(P <0.05).The overall incidence of GERD among patients with abnormal GEFV was higher than that among patients with normal GEFV.This study shows that abnormal GEFV patients are more common in male or people with obese(body mass index 25.1 ± 3.3 vs 23.7 ± 3.4)?satiety?esophageal hiatal hernia?smoking?drinking.The Helicobacter pylori and age of normal and abnormal GEFV groups have no statistic difference.Conclusions The findings from the present study showed a clear association between GEFV and RE?NERD.People with abnormal GEFV were more susceptible to GERD.We can well evaluate and predict the occurrence of reflux according to the GEFV appearance under endoscopy.GEFV can provide effective reference for the diagnosis of GERD,especially for NERD.It is expected to be a routine endoscopic observation index,the diagnostic value of endoscopy will be improved.Besides,GEFV is associated with esophageal hiatal hernia,this study shows that GEFV has no significant relationship with age and Helicobacter pylori;changing lifestyles of smoking?drinking?overeat?and overweight may be useful to reduce the occurrence of abnormal GEFV,thereby reduce the incidence of GERD.