The Characteristics And Clinical Significance Of High Resolution Manometry In Gastroesophageal Reflux Disease Patients In Qinghai Province

Objective: To study the characteristics of High resolution manometry in patients with Gastroesophageal reflux disease,and to discuss the clinical significance of HRM in the diagnosis of GERD patients in Qinghai Province.To accumulate clinical data for diagnosis and treatment of GERD in our province.Methods: Fifty-five GERD patients whose Gerd-Q scores were greater than or equal to 8 with acid reflux,heartburn were selected,during September 2015 to February 2017 in the Affiliated Hospital of Qinghai University,according to the results of gastroscopy,the patients were divided into reflux esophagitis(RE)group(28)and non-erosive gastroesophageal reflux disease(NERD)group(27).During the same period,20 healthy subjects who had no symptoms of gastroesophageal reflux disease were selected as the control group.Collect general information on all subjects(including age,sex,height,weight and blood biochemical parameters).Using HRM to detemine some data,such as their residual pressure.Analysis of the characteristics of HRM in patients with different types of GERD by statistical methods.According to the level of cholesterol,low density lipoprotein and triglyceride,all 55 GERD patients were divided into dyslipidemia group and normal blood lipid group.The characteristics of HRM were compared between the two groups.Results:(1).There was no difference in the resting pressure and residual pressure of UES among RE group,NERD group and normal control group(P > 0.05).(2).The LES resting pressure and LES length in the three groups were not the same(P<0.05),LES resting pressure in RE(8.43±3.58mmHg)and NERD group(10.33±4.04mmHg)are lower than the normal control group(10.33±4.04mmHg)(P<0.05).The length of LES in RE group(2.56±0.51cm)and NERD group(2.92±0.63cm)was shorter than that in control group(3.31±0.61cm)(P<0.05).The length LES in RE group was shorter than that in NERD group(P<0.05).(3).The velocity of 3-11 cm peristaltic wave that above LES was different in three groups(P<0.05),RE group(3.02±0.68cm/s)and NERD group(3.27±0.54cm/s)in the LES above the initial velocity of the peristaltic wave was lower than that in the normal control group(4.03±0.76cm/s)(P<0.05).(4).The DCI was different in that three groups(P<0.05),the value of DCI in normal group(1388.83±508.55 mmHg.s.cm)was greater than that in RE(841.39± 585.13 mmHg.s.cm)and NERD group(936.34±845.92 mmHg.s.cm)(P<0.05).There was difference in DL among three groups(P<0.05).The value of DL in RE group(7.33±0.93s)was higher than that in normal control group(5.84±1.67s)and NERD group(6.08±0.90s).(5).The difference in the proportion of esophageal peristalsis among the three groups was significant(P<0.05)The ratio of weaken and failed peristalsis in GERD group was higher than that in normal control group(P<0.05).(6).There was difference in the resting pressure of LES in patients with normal blood lipids and dyslipidemia in all GERD patients(P<0.05),the LES resting pressure in patients with dyslipidemia(7.46+2.89mmHg)was significantly lower than that in patients with normal blood lipids(10.54+4.00mmHg)(P<0.05).Conclusion:(1).The results of HRM in patients with GERD were different from those of healthy people in Qinghai province,mainly in the LES function,esophageal body movement function and esophageal peristalsis function.(2).Compared with healthy people,the length of LES and the resting pressure decreased in GERD patients,it suggested that the anti reflux barrier was weakened in GERD patients.(3).The shorter the length of the LES,the more severe the reflux and the more severe esophageal mucosal damage,the length of LES in RE patients was shorter than that in NERD patients,and the results were consistent with endoscopic findings.(4).The velocity of 3-11 cm peristaltic wave was slow down,DCI was weakened and DL was extended,it suggested that the reduction of the distal esophageal muscle contraction was the main cause of esophageal motor dysfunction.(5).The ratio of weakened and failed peristalsis was higher in GERD patients.that is one of the reasons that could lead to impaired of esophageal clearance.(6).In patients with GERD,resting pressure of LES in dyslipidemia patients was lower than normal blood lipid patients,it indicated that lipid metabolism might be an important factor which could lead to esophageal anti-reflux barrier weakened.