Correlation between the type of esophagogastric junction and refractory reflux esophagitis.

Objective: To investigate the correlation between refractory gastroesophageal reflux disease (RGERD) and the esophagogastric junction (EGJ), as well as to assess their effect on the efficacy of acid suppression therapy.

Methods: This prospective cohort study (ChiCTR2500101077) enrolled 81 patients with reflux esophagitis (RE) at Pingxiang People's Hospital from April 2023 to September 2024. Participants underwent high-resolution manometry (HRM) to classify EGJ subtypes (I-III) and received an 8-week course of vonorasen fumarate therapy. Refractory reflux esophagitis (RRE) was defined as the persistence of GERD-Q symptoms following treatment. Patients diagnosed with RRE underwent 24-hour pH-impedance monitoring to evaluate the efficacy of acid suppression.

Results: The EGJ subtypes were classified as Type I (n=44), Type II (n=21), and Type III (n=16). After treatment, 37 patients were diagnosed with RRE, including 13 cases of Type I, 12 cases of Type II, and 12 cases of Type III, with significant differences observed among the three groups (P<0.004). The EGJ subtype negatively correlated with LES pressure (r=-0.626, P<0.001). 24 h-pH impedance monitoring demonstrated significant differences in reflux metrics, including total reflux episodes (P<0.001), acid exposure percentage (P<0.001), prolonged reflux episodes (P<0.003), and DeMeester score (P<0.001) among the EGJ subtypes, with correlation coefficients of 0.800, 0.787, 0.489, and 0.800, respectively.

Conclusion: EGJ type significantly influences the development of RRE, with Type III EGJ exhibiting the strongest association. An abnormal EGJ structure reduces LES pressure and increases acid exposure, thereby diminishing the efficacy of acid suppression.