A Study On Association Between Cardiac Polyps And Gastroesophageal Reflux Disease

Background and objectives:Cardiac polyps are not uncommon in clinical practice,and with the increasing development of endoscopic techniques,the attention to cardiac polyps has gradually increased,but overall there are not many studies on cardiac polyps,and so far the pathogenesis of cardiac polyps has not been fully elucidated.More studies have suggested that cardiac polyps are associated with gastroesophageal reflux disease(GERD),which are a reflux-induced mucosal hyperproliferative response,but this conclusion is still controversial.The aim of this study was to investigate the clinical,endoscopic and pathological characteristics of cardiac polyps,and also to explore the correlation between cardiac polyps and GERD initially,in order to pave the way for the next larger sample and more detailed mechanistic study.Methods:Clinical information(including age,gender,history of smoking,history of alcohol consumption,concomitant symptoms,etc.),endoscopic information(GEFV classification,the site,size,and morphology of polyps,etc.)and pathological information(pathological staging of polyps,whether there had intestinalization and intraepithelial neoplasia)were retrospectively collected from January 1,2016 to December 31,2022 from inpatients diagnosed with cardiac polyps via endoscopy at affiliated hospital of Yangzhou University,and data were obtained from the endoscopy system and electronic medical record system.A total of 384 patients with cardiac polyps were included,while 920 patients diagnosed with non-cardiac polyps at the same time were collected as a control group,and the data collected were the same as those of cardiac polyps except for polyp-related.Among the 384 patients with cardiac polyps,a total of 36 patients who underwent both high-resolution esophageal manometry and 24-hour esophageal pH-impedance monitoring were selected,and the corresponding data for these two tests were collected,including DeMeester score,acid exposure time percentage(AET),number of refluxes,upper esophageal sphincter pressure(UESP),lower esophageal sphincter pressure(LESP),4s intact relaxation pressure(IRP),and distal contraction integral(DCI).The study was divided into three parts:the first part analyzed the clinical,endoscopic and pathological data of patients with cardiac polyps;the second part analyzed the correlation between cardiac polyps and non-cardiac polyps after propensity score matching(PSM)and other factors such as gastroesophageal valve valve(GEFV)classification;the third part analyzed 36 patients with cardiac polyps who underwent both high-resolution esophageal manometry(HREM)and 24-hour esophageal pH-impedance monitoring,and compared the clinical,endoscopic and pathological data of cardiac polyps in the group with and without abnormal reflux,as well as the esophageal dynamic data.Results:1.The endoscopic detection rate of cardiac polyps was about 1.6%,the majority of cardiac polyps patients were male(62%),the average age of cardiac polyps patients was 58.00±17.00 years,the average age of women was older than men,and the age difference between men and women was statistically significant(P<0.001).2.Cardiac polyps were mostly single small polyps ≤ 1.0 cm in diameter,and different genders were associated with the size of cardiac polyps(P=0.009),and the polyps of male cardiac polyps patients were larger than those of female.The morphology of cardiac polyps was mainly Yamada type Ⅱ and non-tip,and the treatment was mainly endoscopic high-frequency electrodesiccation with a trap.The rate of H.pylori infection in cardiac polyps was low(11.7%).3.The pathological types of cardiac polyps included proliferative polyps,fundic gland polyps,adenomatous polyps,and squamous epithelial papillomas,most of which were proliferative polyps(95.3%),and the remaining three types were less common.Adenomatous polyps and squamous epithelial papillomas were older than hyperplastic polyps and fundic gland polyps.Multiple polyps were all hyperplastic polyps,while fundic gland polyps,adenomatous polyps and squamous epithelial papillomas were all solitary polyps.4.Some cardiac polyps were accompanied by intestinal epithelial metaplasia and intraepithelial neoplasia.4.2%of cardiac polyps with intestinal metaplasia and 9.9%of cardiac polyps with intraepithelial neoplasia,including 9.1%with low-grade intraepithelial neoplasia and 0.8%with high-grade intraepithelial neoplasia,suggesting that cardiac polyps have a certain malignant tendency.5.The difference between GEFV grading and cardiac polyp site was statistically significant(P=0.013),and there was a weak correlation between them,Cramer’s V=0.130,P=0.022.The difference between GEFV grading and cardiac polyp pathology staging was statistically significant(P=0.038),and there was a weak correlation between them.There was no statistically significant difference between GEFV grading and cardiac polyp size,number,morphology,relationship to dentate line,presence or absence of a tip,surrounding mucosal intestinalization and intraepithelial neoplasia.6.The differences between 384 patients with cardiac polyps and 920 patients with non-cardiac polyps before propensity score matching(PSM)for gender,smoking history,acid reflux symptoms,heartburn symptoms,H.pylori infection,bile reflux,reflux esophagitis,and carditis were statistically significant,with P values of P<0.001,P=0.005,P<0.001,P=0.002,P<0.001,P<0.001,P=0.001,P=0.003.After PSM,the differences in these indices between the two groups were not statistically significant,and further analysis yielded a higher GEFV classification in the cardiac polyp group compared to the non-cardiac polyp group,with statistically significant differences(P<0.001).There were more abnormal GEFV in the cardiac polyp group than in the non-cardiac polyp group,and the difference was statistically significant(P<0.001).7.Univariate logistic regression analysis of cardiac polyps and GEFV after PSM showed an increased risk of cardiac polyps in patients with GEFV class Ⅱ compared with GEFV class Ⅰ(OR=2.880,95%CI:2.059-4.028,P<0.001)and an increased risk of cardiac polyps in patients with GEFV class Ⅲ(OR=4.149,95%CI:2.358-7.300,P<0.001),but patients with GEFV class Ⅳ did not have an increased risk of cardiac polyps,and there was no statistical difference.Compared with controls,those with abnormal GEFV had an increased risk of cardiac polyps(OR=2.910,95%CI:1.720-4.924,P<0.001),and abnormal GEFV was a risk factor for the development of cardiac polyps.8.In 36 patients with cardiac polyps,24-hour esophageal pH-impedance monitoring results with DeMeester score≥14.72 points in 5 cases(13.9%);AET≥ 4.2%in 6 cases(16.7%),suggesting pathological acid reflux;impedance suggesting total number of reflux>80 times in 9 cases(25.0%),suggesting abnormal reflux.HREM results suggesting ineffective esophageal peristalsis(DCI<450 mmHg)in 13 cases(36.1%),including 3 cases(8.3%)with loss of esophageal peristalsis(DCI<100 mmHg)and 10 cases(27.8%)with weak esophageal peristalsis(100<DCI<450 mmHg).There were 4 cases(11.1%)of esophageal hiatal hernia and 16 cases(44.4%)of LESP<13 mmHg.And these 36 patients with cardiac polyps showed reflux esophagitis by gastroscopy in 7 cases(19.4%).It is suggested that patients with cardiac polyps are more often combined with abnormal reflux and abnormal esophageal dynamics,suggesting a correlation between cardiac polyps and gastroesophageal reflux disease.9.The total number of non-acid reflux was more in those with abnormal GEFV than in those with normal GEFV(P=0.044).and LESP was lower in those with anomalous reflux than in those without(P=0.035).The GEFV classification was not correlated with the DeMeester score,AET,standing AET,lying AET,total number of 24-hour acid reflux,number of 24-hour acid reflux times>5 min,the longest acid reflux time,total number of acid refluxes(impedance),total number of weak acid refluxes(impedance),total number of refluxes(impedance),UESP,4s IRP,DCI,total number of acid refluxes(impedance),total number of weak acid refluxes(impedance),total number of refluxes(impedance),acid reflux score(standing),weak acid reflux score(standing),non-acid reflux score(standing),mixed reflux(standing),gas reflux score(standing),acid reflux score(lying),weak acid reflux score(lying),non-acid reflux score(lying),mixed reflux score(lying),and gas reflux score(lying)were not statistically different from each other.There were no differences in age,gender,Hp infection,peptic ulcer,non-erosive esophagitis,reflux esophagitis,carditis,the site,size,number,relationship to dentate line,presence or absence of tip,Yamada typing,pathological type of cardiac polyps,whether polyp mucosal with intestinalization and intraepithelial neoplasia,UESP,LESP,4s IRP,DCI,GEFV between abnormal reflux group and no abnormal reflux group statistically significant.Conclusion:1.The endoscopic detection rate of cardiac polyps is about 1.6%,and the majority of cardiac polyps patients are male,and the average age of women is older than that of men.2.Cardiac polyps are mainly small polyps with a single diameter ≤1.0 cm,endoscopic morphology is mainly Yamada type Ⅱ,non-tip,pathological type of cardiac polyps is mainly proliferative polyps,some polyps with intestinal metaplasia and intraepithelial neoplasia,with some malignant potential.3.Cardiac polyps have more acid reflux and heartburn symptoms,lower Hp infection rate,and more endoscopic patients with reflux esophagitis and carditis than non-cardiac polyps.4.Gastroesophageal valve(GEFV)abnormalities are risk factors for the development of cardiac polyps,and patients with cardiac polyps tend to have higher GEFV classification and more abnormal GEFV.5.The total number of non-acid reflux is higher in patients with abnormal GEFV than in those with normal GEFV,and the resting pressure of the lower esophageal sphincter(LESP)was lower in those with abnormal reflux than in those without normal reflux.