Characteristics Of The Esophageal Motility In Patients With Gastroesophageal Reflux Cough

Objectives:There is one special type of Gastroesophageal reflux disease(GERD)called Gastroesophageal reflux cough(GERC),which is the main cause of chronic cough and seriously affecting the quality of people's life.In many cases the pathogenesis of GERC is a riddle,and the treatment course of the disease is facing a lot of difficulties.Because not only diagnosing GERC is challenging,but also the treatment based on PPI always fails.Esophageal motility disorder is the pathophysiologic of GERD,the different type of GERD has different characteristics of esophageal motility.Through comparing the esophageal motility among the GERC patients,the patients who hasn't suffered from supra-esophageal symptoms,and the healthy volunteer,to find the characteristics of motility of GERC,and search a more reliable method of diagnosis and a more effective treatment for GERC.Methods:We performed a retrospective study of 66 patients of GERD and 18 healthy volunteer in our hospital during the February 2014 to December 2016,all of them had done the detection of HRM.There were two groups in the patients.The one called GERC group was made up of 36 patients of GERC,the other one called n SERD group was composed of 30 patients who hadn't suffered from supra-esophageal symptoms.The data of HRM was compared and analyzed in three groups.Results:1.There showed no significant difference on gender,age,and BMI in three groups.The rate of who were not accompanied by gastrointestinal symptoms was75%(27/36)in the GERC.2.The LESP of 50.0%(33/66)patients was lower than normal.This rate was44.4%(16/36)in the GERC,56.7%(17/30)in the n SERD,and just 5.6%(1/18)in(p=0.323)the healthy control;Pa=0.002<0.05,P1=0.323>0.017,P2=0.004<0.017,P3=0.000<0.017.The LESP of the GERC was similar to that of the n SERD,but significantly lower than that of the healthy control;P=0.026<0.05,P1=0.638>0.017,P2=0.015<0.017,P3=0.016<0.017.The other indexes were not different among three groups,such as LES length,LESP,average LES relaxation,IRP4 s.3.53%(35/66)cases of the GERD had esophageal body motility disorders,in which the ineffective esophageal motility accounted for 36.4%(24/66),the absent contractility or fragmented peristalsis accounted for 6.1%(4/66),the distal esophageal spasm accounted for 4.5%(3/66);and it found 3 ineffective esophageal motility in the healthy control;P=0.023<0.05,P1=0.964>0.017,P2=0.011<0.017,P3=0.012<0.017.The average creep break of the GERC was near to that of the n SERD,but notable longer than that of the healthy control,P=0<0.05,P1=0.762>0.017,P2=P3=0<0.017.The GERC's rate of ineffective swallowing was near to the n SERD's,but significantly higher than the healthy control's,P=0.011<0.05,P1=0.770>0.017,P2=0.005<0.017,P3=0.010<0.017.The other indexes of the esophageal body motility showed no significant difference,such as average DCI,DL.4.The UESP of 16.7%(11/66)patients was lower than normal,this rate was22.2%(8/36)in the GERC,10%(3/30)in the n SERD,and 16.7%(3/18)in the healthy control,it was no significant difference among three groups.The UES length of the GERC was significantly shorter than that of the n SERD,but similar to that of the healthy control,P=0.004>0.05,P1=0.003<0.017,P2=0.727>0.017,P3=0.006<0.017.The UESP of the GERC was lower than that of the n SERD,and closed to the healthy control,but there was no significant difference in three groups.The average rates of UES relaxation was similar among three groups.Conclusions:1.LESP of the GERC is lower than normal,which is similar to the GERD without supra-esophageal symptoms.2.The esophageal body motility of GERC is similar to that of the GERD without supra-esophageal symptoms,and take a common form of the ineffective esophageal motility.3.UES should be impaired in the GERC,which is represented as a losing the ability of extend the UES length,not a reducing of UESP.