Analysis Of The Characteristics Of Esophageal Motility And Reflux In Gastroesophageal Reflux Disease With Chronic Cough Patients

ObjectiveGastroesophageal reflux disease(GERD)is a common gastrointestinal dynamic disease,which is defined as a disease comprising symptoms and complications related to the reflux of gastric contents into the esophageal,oral cavity and the lung.The digestive tract and respiratory tract have the common passage of pharynx,therefore GERD is easy to be combined with respiratory symptoms,especially prone to cough.Reflux and cough have a double-way effects on each other,and reflux can aggravate cough on the basis of primary respiratory disease and lead to refractory cough.In this study,the high resolution manometry(HRM),24-hour esophageal pH and impedance monitoring were used to analyze the differences in esophageal motility and reflux characteristics between GERD with chronic cough and typical GERD patients,to investigate the role of esophageal motility and reflux events in chronic cough patients,and provide guidance for clinical diagnosis and treatment.MethodsFrom January 2016 to June 2018,90 patients were diagnosed as GERD and underwent high resolution manometry,24-hour esophageal pH and impedance monitoring,reflux symptoms score questionnaire and cough symptoms score questionnaire at the First Affiliated Hospital of Zhengzhou University were collected.And they were divided into GERD with chronic cough group and typical GERD group.The general data,esophageal pressure data,24-hour esophageal pH and impedance monitoring data,the score of reflux symptoms and cough symptoms before and after the standardized drug treatment of the two groups were compared and analyzed.Measurement data were compared by t-test or non-parametric test,and enumeration data were compared by Pearson?~2 test or Fisher's exact test.P<0.05was considered statistically significant.Results1.Most of GERD patients were middle-aged and elderly people,and there were no significant differences in gender,age,body mass index,the number of smoking and drinking between GERD patients with and without chronic cough(P>0.05).Among the 31 patients in GERD with chronic cough group,there were 9 patients with primary diseases of otolaryngology or respiratory system,of which chronic pharyngitis accounted for 9.86%(3/31),chronic sinusitis accounted for 3.23%(1/31),asthma accounted for 9.86%(3/31),chronic bronchitis accounted for 16.13%(5/31),interstitial pneumonia accounted for 3.23%(1/31).2.The HRM results showed that GERD with chronic cough group had a higher proportion of ineffective esophageal motility(IEM),the upper esophageal sphincter pressure(UESP)and distal contractile integral(DCI)were lower,and the differences were statistically significant(P<0.05).While there were no significant differences in lower esophageal sphincter pressure(LESP),distal latency(DL),4 seconds integrated relaxation pressure(4sIRP)and the abdominal segment length of lower esophageal sphincter(P>0.05).3.The 24-hour esophageal pH and impedance monitoring results showed that the number of weak acid reflux,gas-liquid mixed reflux,proximal total reflux,proximal weak acid reflux and non-acid reflux in GERD with chronic cough group were higher than GERD group,the differences were statistically significant(P<0.05).And there were no significant differences in the total time of pH?4,the percentage of the total time of pH?4,the longest reflux time,DeMeester score,the number of acid reflux,liquid reflux,proximal acid reflux,reflux at upright and supine position between two groups(P>0.05).4.The reflux symptoms score was higher in typical GERD group than that in GERD with chronic cough group before treatment.The score of reflux symptoms in two groups and the cough symptoms in GERD with chronic cough group were significantly lower after treatment,the differences were statistically significant(P<0.05).Conclusions1.The main esophageal motility disorder in GERD with chronic cough group was IEM.The DCI and UESP were lower,as results,gastric contents was not easy to be removed and were more likely to flow back into the pharyngeal and airway,which may induce or aggravate cough.2.The number of weak acid reflux and gas-liquid mixed reflux in GERD with chronic cough group were significantly higher than that in the typical GERD group,so the symptoms of reflux and heartburn in some patients were not obvious.And the number of proximal total reflux,proximal weak acid reflux and non-acid reflux were higher,which increased the possibility of cough caused by irritation of pharyngeal.3.HRM and 24-hour esophageal pH and impedance monitoring can play a guiding role in the treatment of patients.