基于里昂共识比较胃食管反流病与食管功能性疾病的食管动力学差异

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

目的通过比较胃食管连接部(EGJ)屏障功能、食管体部运动功能和激发试验的差异,分析GERD和食管功能性疾病患者的食管动力学差异。方法选择2016年12月至2018年12月在浙江中医药大学附属第一医院就诊的100例有GERD典型症状的患者,按照罗马Ⅳ标准和里昂共识,结合内镜检查、24 h食管多通道腔内阻抗pH(MII-pH)监测和食管高分辨率测压(HRM)检查结果,将患者分为GERD组(32例)、反流高敏感(RH)组(33例)和功能性胃灼热(FH)组(35例)。根据HRM检测结果,分析各组患者间食管动力学的差异。统计学方法采用t检验、方差分析和卡方检验。结果GERD组的食管下括约肌(LES)静息压低于FH组[(19.37±7.92)mmHg比(25.35±12.38)mmHg(1 mmHg=0.133 kPa)],GERD组和RH组的EGJ收缩积分低于FH组[(20.84±21.52)mmHg·cm、(20.72±19.35)mmHg·cm比(35.93±36.82)mmHg·cm],GERD组的远端收缩积分水平低于FH组和RH组[(802.35±496.86)mmHg·s·cm比(1316.84±853.92)mmHg·s·cm、(1141.65±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)。3组患者均无主要蠕动异常,GERD组的无效食管蠕动发生率高于RH组和FH组[62.5%(20/32)比39.4%(13/33)、25.7%(9/35)],差异均有统计学意义(χ^2=4.440、9.214,P均<0.05)。结论GERD患者存在食管动力异常,主要表现为LES静息压降低、EGJ屏障功能下降、食管体部轻微蠕动异常等;食管RH患者也存在EGJ屏障功能下降。

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 RomeⅣstandand 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.(1316.84±853.92)mmHg·s·cm and(1141.65±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(χ^2=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.