The Role Of Gastroesophageal Valve Flap In The Occurrence Of Gastroesophageal Reflux Disease

Background:In recent years,with the development of the economic level,the national diet structure and nutritional status have undergone great changes,gastroesophageal reflux disease?GERD?has gradually become a common disease in China,and its incidence rate has gradually increased^[1].At present,hiatal hernia has been proved to be a major risk factor for GERD,but the relationship between the intermediate stage from normal cardiac morphology to hiatal hernia and GERD is still unclear.Hill and others from the perspectives of endoscopic introduced gastroesophageal flap valve?GEFV?concept,and the GEFV was be divided into grade I to IV,to reflect the anti reflux barrier structure of esophagogastric junction?EGJ?.This paper focuses on the relationship between GEFV grading and GERD esophageal motility.Objective:To explore the correlations between GEFV grading and HRM parameters and the relationship between GEFV grading and EGJ Chicago type.Also,to explore the relationship between GEFV grading and the severity of esophagitis and briefly analyzes risk factors that may affect GEFV grading.Method:A total of 62 in patients diagnosed with GERD in the gastroenterology department of the first affiliated hospital of Dalian Medical University from October2017 to January 2020 were retrospectively collected.Clinical data of the patients were collected,including basic information:gender,smoking history,drinking history,age,duration of illness,body mass index?BMI?,results of HRM parameters,and the grading of esophagitis and GEFV under gastroscope.All the patients were divided into group i-iv according to the GEFV grading criteria,including 14 GEFV grade I patients,32GEFV grade II patients,9 GEFV grade III patients,and 7 GEFV grade IV patients.?1?Recording HRM related parameters:upper esophageal sphincter?UES?and lower esophageal sphincter?LES?resting pressure,residual pressure,length and researching on the relation between GEFV grading and parameters associated with the HRM;?2?The results of EGJ Chicago type under HRM were recorded to explore the relationship between GEFV grading and HRM EGJ Chicago type.?3?Recording endoscopic esophageal mucosa damage degree,with reference to the Los Angeles grading^[2],the esophageal mucosa in patients without damage for non-erosive reflux diseases?NERD?patients,are recorded as level 0.The patients diagnosed with esophagitis whose esophageal mucosal is damaged divided into:level A,B,C,D,denpending on the degree of esophageal mucosal is damaged,to explore the relations between GEFV grading and severity of esophagitis;?4?record the basic information?gender,smoking history,drinking history,age,duration of illness,BMI?to explore the factors that may affect the form of GEFV.Result:?1?GEFV grading was significantly correlated with LES resting pressure?F=2.911,P=0.042?and negatively correlated?r=-0.359,P=0.004?.GEFV grading was significantly correlated with LES length?F=3.088,P=0.034?and negatively correlated?r=-0.360,P=0.004?.LES residual pressure?P=0.168?,UES resting pressure?P=0.639?,UES residual pressure?P=0.1331?,and UES length?P=0.142?have no clear correlations with GEFV grading.?2?GEFV grading was significantly correlated with EGJ Chicago type?X²=7.863,P=0.005?and positively correlated?r_s=0.304,P=0.016?.As GEFV grading increased,EGJ Chicago type increased under HRM.?3?Among the study subjects,there were 41 NERD patients and 16 esophagitis patients,including 10 patients of grade A,4 patients of grade B,1 patient of grade C and 1 patient of grade D.GEFV grade was significantly correlated with the severity of endoscopic esophagitis?X²=32.838,P=0.000?,and was positively correlated?r_s=0.648,P=0.000?.With the increase of GEFV grade,the severity of esophagitis gradually increased.?4?The average age of the subjects was?61.11±7.42?years old,including 22 males and 40 females.In general data,only age was correlated with GEFV grade?F=5.69,P=0.002?,with a positive correlation?r=0.473,P=0.000?,and the multivariate Logistic regression analysis further proved that age was an independent risk factor for GEFV grade?OR=0.135,P=0.000?.Gender ratio?P=0.564?,smoking history?P=0.882?,drinking history?P=0.186?,duration of illness?P=0.816?,BMI?P=0.653?,and GEFV grading all had no statistical significance.Conclusion:The results of this study confirmed that GEFV grading was negatively correlated with LES resting pressure and LES length,and positively correlated with EGJ Chicago grading,suggesting that the more severe the morphological and structural change of GEFV was,the worse the anti-reflux function of the lower esophagus was,and the higher the severity of endoscopic esophagitis was.Older patients may have higher GEFV ratings.Clinically,the morphology of GEFV is crucial for the evaluation of anti-reflux function and GERD disease.