内镜下阴性胃食管反流病患者食管功能及反流特点研究

[目的]研究反流高敏感(RH)、功能性烧心(FH)与非糜烂性反流病(NERD)患者食管功能及反流特点的差别。[方法]选取于2017年12月～2019年5月在首都医科大学附属北京中医医院消化科同时行胃镜、高分辨率食管测压以及24 h多通路腔内阻抗联合pH监测的141例患者,根据症状及检查结果分为NERD组(42例)、RH组(58例)、FH组(41例),比较3组患者食管测压、24 h食管pH及pH-阻抗情况。[结果]FH组LES静息压、同步收缩百分比显著高于RH组(P0.05);LES长度、LESP下降例数、LES残余压、UES静息压、UES残余压、波幅平均值、无效食管动力、蠕动断裂、DCI平均值、远端收缩延迟、提前收缩百分比、快速收缩百分比3组之间差异均无统计学意义(P0.05);3组间DeMeester评分、总反流次数、立位酸暴露时间占比、近端酸反流次数、远端酸反流次数比较,差异有统计学意义(P0.05)。NERD组总反流时间、长反流次数、最长反流时间、总酸暴露时间占比、卧位酸暴露时间占比显著高于RH组、FH组(P0.05)。NERD组、RH组近端反流次数显著高于FH组(P0.05)。RH组远端弱酸反流次数、近端弱酸反流次数中显著高于FH组(P0.05)。3组远端非弱酸反流事件差异无统计学意义(P0.05)。[结论]3组患者均存在不同程度的食管动力异常,可通过弱酸反流增加、近端反流比率升高将RH、FH精准区分开来。     

OSAHS患者呼吸系统力学特征与胃食管反流相关性的研究

目的评价阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者呼吸系统力学特征及其胃食管反流程度之间的相关性,旨在探讨OSAHS患者发生胃食管反流的可能机制。 方法选取2014年2月至2016年2月,在新疆维吾尔自治区人民医院耳鼻喉科疑似OSAHS首次入院患者,分别行常规肺功能检查、多导睡眠监测(PSG)、脉冲振荡系统(IOS)、24h多通道阻抗-pH监测系统,制定纳入排除标准,259例疑似患者中,确诊为OSAHS患者182例,非OSAHS患者77例;其中127例OSAHS患者伴有病理性胃食管反流(A组);55例OSAHS患者不伴有病理性胃食管反流(B组);23例非OSAHS患者伴有病理性胃食管反流(C组);54例非OSAHS患者不伴有病理性胃食管反流(D组)。比较组间各测量指标差异,并对其做相关分析。 结果A、B、C、D组各组间BMI、AHI、LSaO₂差异均有统计学差异(P<0.05);与B组、C组及D组相比A组的FRC和ERV显著下降,差异有统计学意义(P<0.05);其Zrs5和全部震荡频率的Rrs显著增高,而Xrs显著较低,差异均有统计学意义(P<0.05);食管反流总次数、食管近端酸反流指数和DeMeester评分A组显著高于B、C、D组(P<0.05);相关分析显示：OSAHS患者的Zrs5和5～15 Hz的Rrs与反流总次数、DeMeester评分呈正相关;OSAHS患者Xrs5的下降与反流总次数、DeMeester评分呈负相关。 结论OSAHS患者呼吸系统力学特征发生改变,呼吸阻力增加和呼吸系统弹性特征,尤其是肺的顺应性下降与胃食管反流相关。     

OSA患者的呼吸力学特征及血清肺泡表面活性物质水平与其胃食管反流事件的关系研究

目的通过评价阻塞性睡眠呼吸暂停(OSA)患者呼吸系统力学特征及其血清肺泡表面活性蛋白水平与其胃食管反流事件3者之间的关系,探寻OSA患者呼吸系统力学特性发生变化的可能原因。 方法对连续住院的疑似鼾症患者进行多导睡眠监测(PSG)并诊断,同时分别用脉冲振荡肺功能(IOS)测定其呼吸系统力学特征;酶联免疫吸附法测定血清肺泡表面活性物质蛋白(SP-A,-B,-C,-D)及多通道阻抗-pH监测系统,检测并分析比较胃食管及咽喉部24 h的返流状况。 结果60例经PSG确诊为不同严重程度鼾症的患者,依据其呼吸暂停低通气指数(AHI)将其分为OSAS组与非OSAS进行比较,OSAS组患者的呼吸总阻抗(Zrs5)和全部震荡频率的呼吸阻力(Rrs)显著高于非OSAS组,而呼吸电抗(Xrs)显著降低;OSAS组患者的DeMeester评分及食管近端酸反流、食管反流总值高于非OSAS组,差异具有统计学意义(P<0.01);OSAS患者的血清肺泡表面活性物质蛋白-B水平低于非OSAS组,差异有统计学意义(P<0.01)。OSAS患者的呼吸总阻抗和呼吸阻力(5～15 Hz)与总反流指数和DeMeester评分正相关(r＝0.614,P＝0.031;r＝0.668,P＝0.015;r＝0.569,P＝0.032;r＝0.563,P＝0.034);OSAS患者的Xrs5的下降与其血清肺泡表面活性物质蛋白-B水平存在相关性(r＝－0.594,P＝0.023),而与总反流指数、DeMeester评分负相关(r＝－0.821,P＝0.000;r＝－0.734,P＝0.001)。 结论随着鼾症患者阻塞性睡眠呼吸程度的加重,其呼吸阻力增加,而呼吸电抗(Xrs5)负值增大;OSAS患者的胃食管及食管近端反流与其呼吸暂停低通气指数正相关;该事件与其呼吸阻力正相关,而与其呼吸电抗显著负相关。     

阻塞性睡眠呼吸暂停综合征与胃食管反流病相关性研究

目的研究阻塞性睡眠呼吸暂停综合征(OSAHS)与胃食管反流病(GERD)的相关性。方法选取我院42例OSAHS患者及42例健康体检者为研究对象,分别设定为A、B两组,比较两组食管下括约肌(LES)、食管括约肌(UES)压力,同时进行De Meeter评分,并对所选患者采取阻抗检测,比较两组以上指标差异。结果 A组LES长度、UES持续及恢复时间显著低于B组(P0.05);A组De Meeter评分为(12.25±3.64)分,显著高于对照组的(4.58±1.96)分(P0.05),A组中3例呈胃食管反流阳性;A组酸反流次数、总反流次数显著高于B组(P0.05),弱酸反流次数、非酸反流次数两组比较差异无统计学意义(P0.05)。结论 OSAHS患者有明确的LES和UES异常,少数合并胃食管反流病,酸性物质为食管反流的主要类型。     

国产24h食管pH监测导管数据采集可靠性临床初步研究

[目的]研究国产24h食管pH监测导管与国外同类产品的数据一致性。[方法]对15例胃食管反流病患者同时采用国产24h食管pH监测导管与进口同类产品进行食管pH监测,比较2种导管的总反流时间、直立反流时间、平躺反流时间、反流次数、长反流次数、最长反流时间和DeMeester评分。[结果]国产、进口2种导管均能顺利采集数据,并下载分析。2种导管在总反流时间、直立反流时间、平躺反流时间、反流次数、长反流次数、最长反流次数和DeMeester评分等数据的比较差异无统计学意义(P0.05),数据一致性良好。试验中无不良反应发生。[结论]2种导管采集的数据具有一致性,国产导管有代替进口产品的可能。     

胃食管反流性咳嗽患者食管高分辨率测压及阻抗-pH监测特点探讨

目的应用食管高分辨率测压(high-resolution esophageal manometry,HRM)联合24 h食管多通道腔内阻抗-p H监测(multichannel intraluminal esophageal impedance and p H monitoring,MII-p H)探讨胃食管反流性咳嗽(gastroesophageal reflux cough,GERC)的食管动力和胃食管反流特点。方法收集2014年1月-2014年7月在华中科技大学同济医学院附属同济医院就诊的28例GERC患者,应用HRM测定上食管括约肌(UES)和下食管括约肌(LES)压力、食管体部蠕动功能,同时联合MII-p H观察立位、卧位及餐后酸反流、弱酸反流和非酸反流的次数、食管近端反流的次数和反流类型包括液体反流、混合反流和气体反流及De Meester评分等。以同期仅表现为典型烧心、反酸等胃食管反流症状的胃食管反流病(gastroesophageal reflux disease,GERD)患者作为对照,比较两组食管运动功能及阻抗-p H监测参数之间的差异。结果与典型GERD患者相比,GERC患者的UES静息压力明显降低(P0.01);食管体部近端收缩波幅降低(P0.05);而LES静息压力、食管体部远端收缩波幅和食管体部异常蠕动比例差异无统计学意义(P0.05)。MII-p H结果显示,GERC患者总反流次数和食管近端反流比与典型GERD患者相比,差异无统计学意义(P0.05),但立位反流次数明显高于典型GERD患者(P0.05);两组之间反流类型液体反流和混合反流次数差异无统计学意义(P0.05),但GERC组气体反流次数显著高于典型GERD组(P0.01);两组之间De Meester评分差异无统计学意义(P0.05)。结论 GERC的反流发生机制可能与典型GERD不同,与UES静息压力降低、食管体部近端清除能力下降、食管反流次数尤其气体反流次数和立位反流次数增加有关。     

远端收缩积分和无效食管动力与胃食管反流的关系

目的探讨食管高分辨率测压（HRM）下远端收缩积分（DCI）和无效食管动力（IEM）与GERD 患者反流情况的关系。方法共纳入69例 GERD 患者，均完成食管 HRM、24 h pH 联合阻抗监测检查。应用 Pearson 相关分析研究 DCI、无效吞咽次数和 DeMeester 评分的相关性。根据10次5 mL液体吞咽试验发生无效吞咽的次数分成3组，5～10次无效吞咽为 IEM 组（21例），1～4次无效吞咽为动力异常组（19例），0次无效吞咽为动力正常组（29例），采用 t 检验比较3组平均 DCI、残余的有效吞咽 DCI 平均值、DeMeester 评分、酸反流时间、食团暴露时间、近端反流次数的差异。结果69例 GERD患者中，其10次5 mL 液体吞咽平均 DCI 和 DeMeester 评分呈负相关（r＝－0．363，P ＝0．003），无效吞咽次数和 DeMeester 评分呈正相关（r＝0．374，P ＝0．002）。动力正常组、动力异常组和 IEM 组10次5 mL液体吞咽平均 DCI 分别为（1458．96±545．10）、（986．48±577．50）和（288．50±167．25）mmHg·s·cm， IEM 组低于动力正常组和动力异常组（t＝－11．42、－2．12，P 均＜0．05）。动力正常组、动力异常组和IEM 组残余的有效吞咽 DCI 平均值分别为（1458．96±545．10）、（1187．90±669．40）和（450．78±350．73）mmHg·s·cm，IEM 组低于动力正常组和动力异常组（t＝－8．05、－5．27，P 均＜0．01）。IEM组的 DeMeester 评分为（15．42±8．79）分，高于动力正常组的（6．34±3．45）分，差异有统计学意义（t ＝2．43，P ＜0．05）。IEM 组的酸反流时间、食团暴露时间分别为（54．93±37．07）min、（0．64±0．49）％，分别长于动力异常组的（37．37±22．66）min、（0．52±0．24）％，动力正常组的（21．22±13．98）min、（0．39±0．14）％，差异均有统计学意义（t＝2．36、2．17，2．60、2．54，P 均＜0．05）。IEM 组和动力异常组的总反流次数分别为（67．10±32．94）、（57．26±38．90）次，均多于动力正常组的（44．61±23．84）次，差异均有统计学意义（t＝2．48、2．17，P 均＜0．05）。结论DCI 和无效吞咽次数在一定程度上可预测GERD 患者发生反流的情况，IEM 组食管体部收缩力度最弱，食管对反流物的廓清能力最差。     

体质量对反流性食管炎患者下食管括约肌压力和24h食管pH监测结果的影响

目的探讨反流性食管炎（RE）患者中,体质量对下食管括约肌压力（LESP）和24h食管pH监测结果的影响。方法对18例体质量正常RE患者和22例超重肥胖RE患者进行LESP和24h食管pH监测,对结果进行统计分析。结果超重肥胖组RE患者的LESP、pH〈4总反流时问百分比、反流时间〉5min的反流次数、总反流数、DeMeester分与体质量正常组RE患者比较,差异均有统计学意义（P均〈0．05）;而超重肥胖组RE患者与体质量正常组RE患者的下食管括约肌松弛率（LESRR）比较,差异无统计学意义（P〉0．05）。结论在RE患者中,超重肥胖可影响食管动力并增加食管的酸暴露,控制体质量对治疗RE可能有一定作用。     

无症状贲门松弛患者酸反流食管动力检测及意义

目的:探讨无反流症状贲门松弛对胃食管酸反流及食管动力的影响.方法:对25例内镜下贲门松弛且无明显反流症状患者及10例内镜检查正常的无症状健康志愿者均进行24 h食管pH监测及食管测压检查.结果:内镜下贲门松弛组24 h食管pH监测各项指标较正常对照组增高, 其中以pH<4总时间及DeMeester评分差异更明显(38.44±50.89min vs 10.60±7.75 min, 11.98±14.84 vs 5.06±3.19, 均P<0.05). 贲门松弛组病理性酸反流发生率较正常对照组差异有统计学意义(28%vs 0%, P<0.05). 两组食管测压各项指标包括LES静息压、LES长度、食管远近端蠕动波幅、食管体部传导速度、湿咽成功率等较对照组低, 但差异无统计学意义.结论:贲门松弛易于发生酸反流, 部分贲门松驰且酸反流患者无相关临床症状.     

特发性肺纤维化与胃食管反流的相关性研究

目的 探讨特发性肺纤维化(IPF)与胃食管反流的相关性,分析其临床特点.方法 选2011年1月至2013年10月中国医科大学附属第一医院住院或门诊IPF患者25例(IPF组),另选非IPF的间质性肺疾病患者23例作对照(非IPF组),两组患者行24 h食管pH值监测,分析胃食管反流特点及其临床特征.结果 胃食管反流阳性IPF组16例,非IPF组8例.IPF组DeMeester评分高于非IPF组,差异有统计学意义[(22.8±21.5)分比(15.7±14.0)分;P＜0.05].IPF组长反流(反流时间持续＞5 min)次数[(3.8±4.1)次]、反流指数(1.8±1.7)高于非IPF组[(2.1±2.1)次;1.3±1.2],但差异无统计学意义.IPF胃食管反流阳性者合计反流时间百分比(pH ＜4.0)[(9.2±5.1)％]、直立位反流时间百分比[(8.5±5.2)％]、仰卧位反流时间百分比[(10.8±10.7)％]、反流次数[(54.2±22.7)次]、长反流次数[(6.3±4.2)次]、最长反流时间[(14.5±15.3) nin]、反流指数(2.5±1.7)和DeMeester评分[(34.9±20.3)分]明显高于阴性者,差异有统计学意义(P值均＜0.05).DeMeester评分与胃食管反流病问卷(GerdQ)评分呈正相关(r=0.667,P＜0.01).IPF患者胃食管反流阳性者典型胃食管反流症状:烧心7例,反流6例,多于胃食管反流阴性者(烧心2例,反流1例).结论 IPF患者胃食管反流阳性率高,但往往缺少典型的胃食管反流症状.在不具备胃酸监测条件的医院,GerdQ可用于评价IPF患者是否存在胃食管反流.     

Absence of an Upper Esophageal Sphincter Response to Acid Reflux

Manometric studies of the upper esophageal sphincter (UES) were done on 17 volunteer subjects and 16 patients with endoscopically evident esophagitis. Subjects entered one or both of two protocols designed to assess the effect of esophageal acid exposure on UES pressure. In protocol 1, continuous 3-h postprandial recordings were obtained; a modified sleeve sensor was used to measure UES pressure, and an intraluminal pH electrode was used to detect occurrences of spontaneous gastroesophageal acid reflux. In protocol 2, UES pressure was continuously monitored during a 10-min control period, followed by a 25-min period of esophageal perfusion with 0.1 N HCl. Our findings were that: 1) basal UES pressure measured during the 3-h recording was similar in the normal volunteers and in the group of patients with esophagitis, 2) episodes of spontaneous gastroesophageal acid reflux were not associated with a change in UES pressure in either the normal volunteers or in the patients with esophagitis, and 3) esophageal perfusion with HCl did not affect the UES pressure in either group, although severe heartburn occurred in most of the esophagitis patients. We conclude that the upper esophageal sphincter exhibits normal basal pressure in patients with esophagitis and that esophageal acid exposure, either spontaneous or experimental, does not affect UES pressure in normal volunteers or in patients with esophagitis.     

Upper esophageal sphincter function during belching

We studied the mechanism of belching with specific attention to the upper esophageal sphincter (UES) in 14 normal volunteers. Belching occurred by the following sequence of events: lower esophageal sphincter relaxation; gastroesophageal gas reflux, recorded manometrically as a gastroesophageal common cavity phenomenon; UES relaxation; esophagopharyngeal gas reflux; and restoration of intraesophageal pressure to baseline by a peristaltic contraction. Upper esophageal sphincter relaxations comparable to those associated with belches were induced by abrupt esophageal distention with air boluses. In contrast, fluid boluses injected into the midesophageal body either had no effect on UES pressure or increased UES pressure. Thus, the UES responded to esophageal body distention in two distinct ways: abrupt relaxation in response to air boluses and pressure augmentation in response to fluid boluses. Mucosal anesthesia did not alter the UES response to esophageal boluses of gas or liquid thereby making it unlikely that these substances are differentiated by a mucosal receptor. Rapid distention of the proximal esophagus with a cylindrical balloon (15 cm long) elicited UES relaxation. These findings suggest that the rapidity and spatial pattern of esophageal distention, rather than discrimination of the type of material causing the distention, determines whether or not UES relaxation occurs.     

Transient lower esophageal sphincter relaxations are no more frequent in patients with gastroesophageal reflux disease than in asymptomatic volunteers

OBJECTIVES: Studies of the relative frequency of transient lower esophageal sphincter relaxations (TLESRs) in patients with gastroesophageal reflux disease and asymptomatic controls have revealed conflicting data. We have therefore studied the frequency of TLESRs and the frequency and mechanisms of acid reflux episodes in patients with gastroesophageal reflux disease and age- and sex-matched asymptomatic controls using standardized criteria. METHODS: Ten patients with symptomatic gastroesophageal reflux disease (four male, aged 50 [30-59] yr) and 10 asymptomatic matched volunteers (four male, aged 50 [32-59] yr) were studied. Esophageal, lower esophageal sphincter, and gastric manometric and esophageal pH readings were recorded for 1 h before and 1 h after a 200-kcal, 150 ml long-chain triglyceride meal. RESULTS: TLESR frequency increased after the meal in both volunteers (median 0 [range = 0-3] to 3 [0-8] per hour,p < 0.01) and patients (1 [0-6] to 2.5 [0-9] per hour, p = 0.08). There was no significant difference in the frequency of TLESRs between volunteers and patients. TLESRs were more likely to be associated with acid reflux in patients (65% vs 37%, p = 0.03), whereas volunteers were more likely to reflux gas or liquid without acid (30% vs 3.0%, p = 0.01). CONCLUSIONS: TLESRs are no more frequent in patients with gastroesophageal reflux disease than age- and sex-matched asymptomatic volunteers. However, when TLESRs occur in patients, they are twice as likely to be associated with acid reflux.     

Study in oral cavity alterations in patients with gastroesophageal reflux disease

BACKGROUND: The gastroesophageal reflux disease, which has become highly and increasingly incident, may be manifested by typical (pyrosis and regurgitation) and atypical (pulmonary, otorhinolaryngological and buccal) symptoms. AIM: To analyze alterations in the oral cavity patients with gastroesophageal reflux disease. METHODS: One hundred patients were studied being 50 gastroesophageal reflux disease patients (group 1) and 50 controls (group 2). All patients were submitted to an oral clinical exam and specific survey. Patients in group 1 were submitted to upper endoscopy, manometry and esophageal pH monitoring. RESULTS: The upper endoscopy revealed esophagitis in all patients, 20 erosive esophagitis, 30 no-erosive esophagitis and 38 hiatal hernia. Average pressure of the lower esophageal sphincter was 11 +/- 4,8 mm Hg and of the upper esophageal sphincter 75 +/- 26,5 mm Hg. In 42 patients of group 1 (84%) pathological gastroesophageal reflux was observed. Clinical exams revealed: dental erosions in group 1: 273 faces and in group 2: 5 tooth decays in group 1: 23 and 115 in group 2; abrasion in group 1: 58 and in group 2: 95; attrition wear: 408 in group 1 and 224 in group 2. The most damages was the palatine face. In group 1, 21 patients complained about frequent episodes of canker sores, 35 of tooth sensibility, 26 of burning mouth and 42 of sour taste in the mouth. In group 2 the complaints were observed in lower number of patients. CONCLUSIONS: Patients with gastroesophageal reflux disease present higher incidence of dental erosion, canker sores, mouth burning sensation, sensitivity and sour taste than controls. Patients with gastroesophageal reflux disease show lower incidence of tooth decays as compared to controls.     

Upper esophageal sphincter and esophageal motility in patients with chronic cough and reflux: assessment by high‐resolution manometry

The pathophysiology of chronic cough and its association with dsymotility and laryngopharyngeal reflux remains unclear. This study applied high‐resolution manometry (HRM) to obtain a detailed evaluation of pharyngeal and esophageal motility in chronic cough patients with and without a positive reflux–cough symptom association probability (SAP). Retrospective analysis of 66 consecutive patients referred for investigation of chronic cough was performed. Thirty‐four (52%) were eligible for inclusion (age 55 [19–77], 62% female). HRM (ManoScan 360, Given/Sierra Scientific Instruments, Mountain View, CA) with 10 water swallows was performed followed by a 24‐hour ambulatory pH monitoring. Of this group, 21 (62%) patients had negative reflux–cough SAP (group A) and 13 (38%) had positive SAP (group B). Results from 23 healthy controls were available for comparison (group C). Detailed analysis revealed considerable heterogeneity. A small number of patients had pathological upper esophageal sphincter (UES) function (n = 9) or esophageal dysmotility (n = 1). The overall baseline UES pressure was similar, but average UES residual pressure was higher in groups A and B than in control group C (?0.2 and ?0.8 mmHg vs. ?5.4 mmHg; P < 0.018 and P < 0.005). The percentage of primary peristaltic contractions was lower in group B than in groups A and C (56% vs. 79% and 87%; P = 0.03 and P < 0.002). Additionally, intrabolus pressure at the lower esophageal sphincter was higher in group B than in group C (15.5 vs. 8.9; P = 0.024). HRM revealed changes to UES and esophageal motility in patients with chronic cough that are associated with impaired bolus clearance. These changes were most marked in group B patients with a positive reflux–cough symptom association.     

Upper esophageal sphincter abnormalities and high-resolution esophageal manometry findings in patients with laryngopharyngeal reflux

Background: The association between laryngopharyngeal reflux (LPR) and abnormalities of upper esophageal sphincter (UES) and esophageal motility is not clearly known. High-resolution esophageal manometry (HREM) has allowed accurate measurement and evaluation of UES and esophageal function.

Goals: To evaluate the UES function and esophageal motility using HREM in patients with LPR and compare them to patients with typical gastroesophageal reflux disease (GERD).

Study: All patients evaluated for GERD or LPR symptoms with esophageal function testing including HREM, ambulatory distal pH monitoring and upper endoscopy between 2006 and 2014 were retrospectively studied (n?=?220). The study group (group A, n?=?57) consisted of patients diagnosed with LPR after comprehensive evaluation. They were compared to patients who had typical GERD symptoms only (group B, n?=?98) and patients with both GERD and LPR symptoms (group C, n?=?65).

Results: Abnormalities in UES pressures and relaxation were found in about one-third of patients in all groups. There were no significant differences between the groups. Group B had higher prevalence of abnormal esophageal motility compared to others (group A vs. B vs. C?=?20.8% vs. 28% vs. 12.5%, p?=?.029). Group B patients also had higher prevalence of Barrett’s esophagus compared to others (group A vs. B vs. C?=?0% vs.12.2% vs. 4.6%, p?=?.01). Distal pH testing revealed no significant differences between the three groups.

Conclusions: Abnormal UES function was noted in one-third of patients with LPR or GERD. However, there were no abnormalities on esophageal function testing specific for LPR.     

Correlation of esophageal pH and motor abnormalities with endoscopic severity of reflux esophagitis

Motility abnormalities, common in gastroesophageal reflux disease, are likely to be related to endoscopic esophagitis. We studied pH and manometry parameters in relation to the severity of esophagitis. Forty-seven patients with symptomatic gastroesophageal reflux disease for > 3 months were evaluated by: (i) endoscopy (grading of esophagitis by Savary-Miller classification); (ii) mucosal biopsy; (iii) manometry; and (iv) 24-h pH-metry. We found Savary-Miller's grades of: 0 (9 patients out of 47), I (16/47), II (16/47), III (4/47), IV (2/47). Distal esophageal contraction amplitude was lower in severe (grade II to IV) as compared with mild (grade 0 and I) esophagitis (49 [7-182] versus 83 [27-196] mmHg [P = 0.001]). The length and pressure in the lower esophageal sphincter (LES), duration and velocity of contraction in the body, number of episodes of reflux and long-duration reflux, longest reflux, median pH, per cent of time with pH < 4 and DeMeester scores were not significantly different between the two groups. The area under pH 4 showed a negative correlation with LES pressure and amplitude of distal esophageal contractions. We conclude that higher endoscopic grades of esophagitis are associated with lower amplitude of contraction in distal esophagus. Lower LES pressure and distal esophageal contraction amplitude are associated with greater area under curve for pH below 4.     

Endoluminal delivery of radiofrequency energy to the gastroesophageal junction in uncomplicated GERD: efficacy and potential mechanism of action

OBJECTIVES: The endoluminal delivery of radiofrequency energy to the gastroesophageal junction has been shown to decrease symptoms of gastroesophageal reflux disease in a multicenter study. In this single-center trial, we sought to further examine its efficacy and physiological effects in patients with uncomplicated gastroesophageal reflux disease. METHODS: Patients with chronic heartburn requiring maintenance antisecretory therapy but without a hiatal hernia >2 cm, severe esophagitis, or complications of gastroesophageal reflux disease were prospectively studied. Radiofrequency energy was delivered to the gastroesophageal junction using a transorally delivered, flexible bougie-tipped catheter and a thermocouple-controlled generator, under sedation and analgesia. The primary outcome measure was effect on reflux symptoms, assessed at baseline and at 1, 3, and 6 months, after treatment. Other outcome measures included effects on antireflux medication use, quality of life, overall patient satisfaction, esophageal motility, esophageal acid exposure, esophageal wall thickness, appearance of the cardioesophageal flap valve, and vagal efferent function. RESULTS: A total of 18 patients underwent successful outpatient treatment without a serious adverse event. A significant improvement in symptom scores (Gastroesophageal Reflux Disease [GERD] Activity Index: 112.5 [range 76.2-140.6] vs 81.0 (74.2-97.6); p < 0.0001) and antacid use (17/wk [range 0-81] vs 0 (0-10); p < 0.0001) was noted at 6-month follow-up. No adverse effect on abdominal vagal function was identified and no significant change in any esophageal motility parameter was seen; however, a trend was noted toward a reduction in the number of transient lower esophageal sphincter relaxations induced by gastric air distension (3.5/h vs 1.0/h, p = 0.13). No detrimental effects on peristalsis or swallow-induced lower esophageal sphincter relaxation pressure were seen. Nonsignificant trends (p = 0.06) were noted regarding a decrease in the Hill score and an increase in esophageal wall thickness after treatment. Finally, although a decrease in all pH parameters in both the upper and lower esophagus was seen, none reached statistical significance. CONCLUSIONS: Radiofrequency energy delivery to the region of the gastroesophageal junction provides effective symptom relief over the short term in patients with uncomplicated gastroesophageal reflux disease. It may achieve its therapeutic effect by reducing the frequency of transient lower esophageal sphincter relaxations triggered by gastric distension.     

Lower-esophageal sphincter function does not determine resting upper-esophageal sphincter pressure

Records of 269 esophageal motility studies were reviewed to determine the relationship between lower-esophageal sphincter (LES) function and upper-esophageal sphincter (UES) pressure. Average and greatest UES pressures were similar in patients with LES pressures less than 10 mm Hg or greater than 20 mm Hg, and in patients with and without gastroesophageal reflux as determined by an intraesophageal pH electrode test. Although teliologically appealing, the belief that patients with weak lower-esophageal sphincters and gastroesophageal reflux have stronger upper-esophageal sphincters to guard against pharyngeal reflux and aspiration cannot be confirmed by current manometric techniques.