Comparison of esophageal motility between gastroesophageal reflux disease and functional esophageal disorders based on Lyon consensus

Xiaodong Ying, M. Li, Chaoqiong Jin, B. Lyu
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Abstract

Objective To analyze the differences in esophageal motility between patients with gastroesophageal reflux disease (GERD) and functional esophageal disorders by comparing the esophagogastric junction (EGJ) barrier function, esophageal body motor function and results of provocative test. Methods From December 2016 to December 2018, the 100 patients with typical symptoms of GERD, who visited The First Aftiliated Hospifal of Zhejiang Chinese Medical Universtiy wese selected. According to the Rome Ⅳ standand and the Lyon consensus, and the results of endoscopic examination, 24 h multichannel intratuminal impedante pH (MII-pH) monitoring and esophageal high resolution manometry (HRM), the patients were divided into GERD group (n=32), hypersensitivity(RH) group (n=33) and functional heartburn(FH) group (n=35). According to the results of esophageal HRM, the differences in esophageal dynamics among the groups were analyzed. T test, variance analysis and Chi square test were performed for statistical analysis. Results The lower esophageal sphincter (LES) resting pressure of GERD group was lower than that of FH group ((19.37±7.92) mmHg vs. (25.35±12.38) mmHg (1 mmHg=0.133 kPa)); the EGJ-contractile integral of GERD group and RH group was lower than that of FH group ((20.84±21.52) mmHg·cm and (20.72±19.35) mmHg·cm vs. (35.93±36.82) mmHg·cm), and the level of distal contractile integral of GERD group was lower than that of FH group and RH group ((802.35±496.86) mmHg·s·cm vs. (1 316.84±853.92) mmHg·s·cm and (1 141.65±607.93) mmHg·s·cm), and the differences were statistically significant (t=-2.377, -2.069, -2.149, -3.045 and -2.467, all P<0.05). There were no major motility disorders in patients of the three groups. The incidence of ineffective oesophageal motility of GERD group was higher than that of RH group and FH group (62.5%(20/32) vs. 39.4%(13/33) and 25.7%(9/35)), and the differences were statistically significant (χ2=4.440 and 9.214, both P<0.05). Conclusions GERD patients have abnormal esophageal motility, which is mainly manifested by reduced LES resting pressure, decreased EGJ barrier function, and abnormal peristalsis of the esophagus. Patients with RH also have decreased EGJ barrier function. Key words: Gastroesophageal reflux; Functional heartburn; Reflux hypersensitivity; High resolution manometry; Lyon consensus
基于Lyon共识的胃食管反流病与功能性食管疾病的食管运动比较
目的通过比较食管胃交界(EGJ)屏障功能、食管体运动功能及刺激试验结果,分析胃食管反流病(GERD)与功能性食管疾病患者食管运动功能的差异。方法选取2016年12月至2018年12月在浙江中医药大学第一附属医院就诊的100例有典型胃食管反流症状的患者。根据RomeⅣ标准和Lyon共识,结合内镜检查、24 h多通道腔内阻抗pH (MII-pH)监测和食管高分辨率测压(HRM)结果,将患者分为GERD组(n=32)、超敏(RH)组(n=33)和功能性烧心(FH)组(n=35)。根据食道HRM结果,分析各组间食道动力学的差异。采用T检验、方差分析和卡方检验进行统计学分析。结果GERD组食管下括约肌静息压明显低于FH组((19.37±7.92)mmHg vs(25.35±12.38)mmHg (1 mmHg=0.133 kPa);GERD组和RH组egj -收缩积分低于FH组((20.84±21.52)mmHg·cm和(20.72±19.35)mmHg·cm比(35.93±36.82)mmHg·cm), GERD组远端收缩积分低于FH组和RH组((802.35±496.86)mmHg·s·cm比(1 316.84±853.92)mmHg·s·cm和(1 141.65±607.93)mmHg·s·cm),差异均有统计学意义(t=-2.377、-2.069、-2.149、-3.045、-2.467,P均<0.05)。三组患者均无重大运动障碍。GERD组食管运动不良发生率高于RH组和FH组(62.5%(20/32)、39.4%(13/33)、25.7%(9/35),差异有统计学意义(χ2=4.440、9.214,P均<0.05)。结论GERD患者食管运动异常,主要表现为LES静息压降低,EGJ屏障功能下降,食管蠕动异常。RH患者也有EGJ屏障功能下降。关键词:胃食管反流;功能性胃灼热;回流过敏;高分辨率测压法;里昂的共识
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