Analysis On The Correlation Between Esophageal Dynamic Characteristics And Symptoms Of Patients With Gastroesophageal Reflux Disease

Background and objectiveGastroesophageal reflux disease(GERD)is widespread among digestive disorders and includes different types.The clinical manifestations of patients with GERD are varied,including typical symptoms,atypical symptoms and extraesophageal symptoms.GERD is related to many factors,among which esophageal motility disorders are closely related.Therefore,this study aimed to investigate the esophageal dynamic characteristics and symptom characteristics of patients with different types of GERD.Besides,this study compared the esophageal dynamic characteristics of GERD patients with different extraesophageal symptoms and analyzed the correlation between them and symptoms,so as to analyze the pathogenesis of GERD and help to establish individualized treatment.MethodsPatients with GERD symptoms who visited or were hospitalized in the Second Hospital of Shandong University from January 2018 to October 2021 and met the inclusion criteria were included in the study.The enrolled patients underwent gastroscopy and were divided into three groups according to endoscopic manifestations as follows:non-erosive reflux disease(NERD)group,45 cases;reflux esophagitis(RE)group,44 cases;and Barrett’s esophagus(BE)group,12 cases.Esophageal high-resolution manometry(HRM)and the Gastroesophageal Reflux Disease Questionnaire(GerdQ)were used to investigate the characteristics of esophageal dynamics and symptoms.In addition,the reflux symptom index(RSI)was completed and the patients were divided into different groups according to presence or absence of extraesophageal symptoms and specific extraesophageal symptoms.We then determined the correlation between esophageal dynamic characteristics and clinical symptoms to explore the mechanism of extraesophageal symptoms.Results1.The analysis of esophageal dynamics in the NERD,RE and BE groups showed that the upper(UES)and lower(LES)esophageal sphincter pressures and the 4-second integrated relaxation pressure(IRP4s)in the RE group were lower than those in the NERD group(20.50 vs 30.00mmHg,7.00 vs 11.00mmHg,1.66 vs 2.47mmHg,P<0.05).The IRP4s in the BE group was also lower than that in the NERD group(0.84 vs 2.47mmHg,P<0.05).The results showed that although there was no statistical difference in the NERD,RE and BE groups(P>0.05),DCI was increasingly smaller,PB and the times of PB>5cm showed an increasing tendency among the three groups.2.The analysis of symptoms in the NERD,RE and BE groups showed there was no statistical difference in the total GerdQ scores and the scores for each symptom among patients in the three groups(P>0.05).3.Analysis on the correlation between HRM and RSI showed that there were significant differences in UES pressures among all groups(P<0.05).Further subgroup analysis showed that compared with the group without extraesophageal symptoms,the UES pressure in the groups with pharyngeal foreign body sensation,throat clearing,and multiple extraesophageal symptoms was lower(16.00 vs 30.00mmHg,16.00 vs 30.00mmHg,19.45 vs 30.00mmHg,P<0.05).In addition,the UES pressure in the group with pharyngeal foreign body sensation was lower than that in the group with hoarseness(16.00 vs 74.50mmHg,P<0.05).4.There was no statistical significance in sleep quality among the NERD,RE and BE groups(P>0.05).However,in the analysis of extraesophageal symptoms,the difference in sleep quality among different groups was statistically significant(P<0.05).The comparative analysis between the groups showed that patients with cough and expectoration had worse sleep quality than those without extraesophageal symptoms,those with difficulty in swallowing,and those with multiple extraesophageal symptoms(12.50 vs 6.50,12.50 vs 7.00,12.50 vs 6.00,P<0.05).Conclusions1.As GERD severity increases,motor dysfunction of the LES and esophageal body gradually worsens,and the LES plays an important role in the development of GERD.2.There was no significant correlation between clinical symptoms and endoscopic severity of GERD.3.Decreased UES pressure plays an important role in the occurrence of extraesophageal symptoms,which is more noticeable in patients with pharyngeal foreign body sensation and throat clearing.4.Extraesophageal symptoms obviously affect sleep quality of patients with GERD,and cough and expectoration has a greater impact on sleep quality.