胃镜下胃食管阀瓣分级与基于里昂共识的胃食管反流病证据等级及反流新参数的相关性

目的探讨胃镜下胃食管阀瓣(gastroesophageal flap valve, GEFV)分级与基于里昂共识的胃食管反流病(gastroesophageal reflux disease, GERD)证据等级、平均夜间基线阻抗(mean nocturnal baseline impedance, MNBI)、反流后吞咽诱发的蠕动波指数(post-reflux swallow-induced peristaltic wave index, PSPWI)的相关性。方法收集就诊于首都医科大学附属北京同仁医院消化内科有典型胃食管反流症状且完成胃镜、24 h食管pH-阻抗监测及食管高分辨测压(high-resolution manometry, HRM)的421例患者。回顾性分析胃镜下GEFV分级与基于里昂共识的GERD证据等级、食管pH-阻抗监测常规指标,即总反流次数、pH<4时间百分比AET4(%)]、DeMeester评分及新参数(MNBI及PSPWI)的关系。结果异常GEFV(GEFVⅢ+Ⅳ级)占所有患者的29.5%,在确定性GERD证据组比例最高(49.6%)。GEFV异常组的男性比例、糜烂性食管炎比例、AET4(%)、总反流次数显著高于GEFV正常组,而MNBI、PSPWI显著降低(P<0.05)。男性、BMI、AET4(%)、DeMeester评分、总反流次数与GEFV分级呈显著正相关,MNBI、PSPWI与GEFV分级呈显著负相关(P<0.05)。结论基于里昂共识的确定性GERD证据的患者中GEFV异常比例最高,GEFV异常提示糜烂性食管炎发生率升高、更重的反流负荷、MNBI及PSPWI降低。

The association of gastroesophageal flap valve grading with classification of gastroesophageal reflux disease by Lyon Consensus and novel parameters of pH-MII monitoring

Objective To investigate relationships between gastroesophageal flap valve(GEFV) grading and the classification of gastroesophageal reflux disease(GERD) by Lyon Consensus, and 2 novel metrics on ambulatory reflux monitoring, with mean nocturnal baseline impedance(MNBI) and post-reflux swallow-induced peristaltic wave index(PSPWI) included.Methods Included 421 patients who had typical gastroesophageal reflux symptoms and completed endoscopy, 24-hour esophageal pH-impedance monitoring and high-resolution manometry(HRM) in the Department of Gastroenterology, Beijing Tongren Hospital, Capital Medical University. Relationships between GEFV grading and the classification of GERD by Lyon Consensus and parameters of pH-MII, such as conventional metrics, total reflux events, AET4(%), DeMeester score and novel metrics, esophageal proximal MNBI, distal MNBI and PSPW index on pH-MII, were retrospectively analyzed. Results The abnormal GEFV(Ⅲ+Ⅳ) accounted for 29.5% in all patients and was found in 49.6% of patients with conclusive evidence for GERD. The male, esophagitis proportion, AET4(%), number of reflux event were significantly higher, whereas MNBI and PSPWI were lower in abnormal GEFV when compared with normal GEFV patients. Male, BMI, AET4(%), DeMeester score and total reflux events were significantly positively correlated with GEFV grade, while MNBI and PSPWI significantly negatively correlated with GEFV grade. Conclusion Abnormal GEFV is associated with conclusive evidence for GERD, higher reflux burden, and lower MNBI and PSPWI.