The Clinical Research Of Refractory Gastroesophageal Reflux Dynamics

Objective:Comparedwith refractory gastroesophageal reflux disease and non-refractory gastroesophageal reflux disease in the general clinical data,high-resolution esophageal pressure measurement and 24-hour pH-Impedance Monitoring indexes.To investigate the dynamic characteristics and acid exposure characteristics of refractory gastroesophageal reflux disease.Methods:The study participants were selected from the Department of Gastroenterology out-patient and in-patient Department of the first affiliated Hospital of Medical College of Shihezi University from Oct 2018 to Nov 2019.All patients were subjected to Gastroscopy,high resolution esophageal manometry,24 h esophageal pH-impedance monitoring,C14 breath test and so on.We need to record general information(such as gender,age,height,weight,smoking history,drinking history,etc.)and the results of the inspection.According to the effect of PPI treatment,the patients were divided into refractory reflux disease group and non-refractory gastroesophageal reflux disease group.Univariate and multivariate analyses were performed to determine predictors of refractory gastroesophageal reflux disease.Results:A total of 87 patients were included in the study,there were 29 refractory GERD and 58 GERD.There were no statistically significant differences in gender,age,body mass index,smoking,alcohol consumption,external esophageal symptoms,and the proportion of reflux esophagitis diagnosed under gastroscope between the two groups.The basal LES stress,EGJ-CI and DCI of patients with refractory gastroesophageal reflux disease were higher than those of patients with non-refractory gastroesophageal reflux disease,and the differences were statistically significant(P<0.001).According Chicago Classification,there was no statistical difference in the composition ratio among the subtypes,DeMeester score and more acid reflux longer than 5 min of refractory gastroesophageal reflux disease patients was significantly higher than that of the non-refractory gastroesophageal reflux disease group(P<0.001).However,the numbers of total reflux was not statistically different between the two group(P = 0.287).There was no significant difference in the number of liquid reflux,gas reflux and mixed reflux between the two groups.Multivariate analysis revealed that the basal LES pressure,DeMeester score,and the numbers of acid reflux were an independent risk factor for rGERD(P = 0.003,0.002,0.001,respectively).In particular,the number of acid reflux Medium risk affect the occurrence of intractable gastroesophageal reflux disease of the most significant(OR = 2.876,95% CI 1.466-5.641).However,EGJ Ⅲ type as a reference to the sub-variable type EGJ Ⅰ,EGJ Ⅱ had no statistical significance in multivariate analysis.Conclusion:1.Increased basal LES pressure,DeMeester score,and more acid reflux longerthan 5 minare the independent risk factors for diagnosis of refractory gastroesophageal reflux disease.2.The type of EGJ may be a predictor of refractory gastroesophageal reflux disease.