Changes of esophageal intraluminal baseline impedance in 47 reflux esophagitis / 中华消化杂志

Objective To investigate the changes of esophageal intraluminal baseline impedance in patients with refluxesophagitis.Methods From December 2013 to August 2014,47 patients with reflux esophagitis and 17 healthy controls were enrolled.The patients with reflux esophagitis were graded according to Los Angeles classification (LA) grading standards.All subjects accepted 24 h multichannel intraluminal impedance (MII) pH examination,and the baseline value of impedance were measured.Independent sample t test was used to compare the difference in impedance between the two groups.Spearman rank correlation coefficient was performed to analyze the correlation between acid exposure time (AET) and the baseline impedance of patients with reflux esophagitis.Kruskal-Wallis test was used to compare the differences in baseline impedance of patients with different grades of reflux esophagitis.Results The impedance baseline value of reflux esophagitis group was (1 676.72±644.41) Ω,which was lower than that of healthy control group ((2 151.27± 322.05) Ω),and the difference was statistically significant (t =-3.883,P＜0.01).The AET of esophagus was negatively correlated with the baseline impedance of the patients with reflux esophagitis (r=-0.530,P＜0.01).The baseline impedance of patients with grade LA-A and grade LA-B reflux esophagitis were 1 823.62 Ω (1 515.38 52 Ω,2 208.38 Ω) and 1 771.81 Ω(1 304.75 52 Ω,2 080.50 Ω),respectively,and the difference was not statistically significant (Z=-0.630,P=0.529).The baseline impedance of patients with grade LA C/D reflux esophagitis was 300 Ω (300 Ω,500 Ω),which was obviously lower than those of patients with grade LA-A or grade LA-B (Z=-2.647 and-2.818,both P＜0.017).Conclusion The baseline impedance of patients with reflux esophagitis is low and correlated with AET.

Characteristics of achalasia:a high-resolution manometry study / 中华消化内镜杂志

Objective To evaluate the clinical and manometric characteristics of achalasia.Meth-ods Patients diagnosed as having achalasia from July 2010 to July 2014 at our hospital were enrolled.High resolution manometry(HRM)results were analyzed.Data of Eckardt scale,MDADI and SF-36 were ana-lyzed.Results All subjects had dysphagia,35.6% (37 /104)accompanied with regurgitation,26.9%(28 /104)with heartburn and 17.3%(18 /104)with weight loss.According to HRM results and Chicago classification criteria,16.35%(17 /104)of the subjects were classified as type Ⅰ,76.92%(80 /104)as type Ⅱ and 6.73%(7 /104)as type Ⅲ.27.9%(29 /104),19.2%(20 /104)and 24.0%(25 /104)of the subjects finished Eckardt scale,MDADI and SF-36,respectively.Eckardt score was positively correlated with integrated relaxation pressure(IRP)(r =0.421,P <0.05)and MDADI physical score was negatively with IRP(r =-0.530,P <0.05).Conclusion Dysphagia often occurs as the chief complaint among acha-lasia patients.And type Ⅱ is the most common.IRP is an indicator of the severity of clinical symptoms and impairment of quality of life.

The prevalence of non-acidic reflux and its relation with heartburn symptoms in patients with gastroesophageal reflux disease / 中华消化杂志

Objective To investigate the prevalence of non-acidic reflux in patients with gastroesophageal reflux disease and its correlation extent with heartburn symptom by 24-hour combined multichannel intraluminal impedance-pH (MII-pH) monitoring. Methods Consecutive patients with chief complain of heartburn in gastrointestinal specialty clinic were enrolled. Patients were divided into erosive esophagitis (EE) group, non-erosive reflux disease (NERD) group after upper gastrointestinal endoscope, further diagnosed with 24-hour combined MII-pH monitoring and rabeprazole test. The MII-pH parameters were compared in these two groups. Results 36 cases of EE and 62 of NERD were enrolled. There was significant difference in acidic reflux frequency and acidic reflux time percentage between these two groups (P=0. 001 and 0. 002). The frequency of non-acidic reflux in EE and NERD groups was 37.3% (663/1777) and 44.3% (1220/2754) respectively (x2 =21. 723,P = 0. 000). The percentage of heartburn symptom positive index in patients with acidic reflux, non-acidic reflux , and total reflux in EE group was 36.1 % (13/36), 19.4 % (7/36) and 55.6%(20/36) respectively, while in NERD group was 27. 4% (17/62), 6.4 % (4/62) and 33.8% (21/62).Conclusion The percentage of non-acidic reflux in EE and NERD groups was 37.3% and 44.3%respectively, and the non-acidic reflux was highly related to heartburn symptom.

Effect of esomeprazole with different dosage and usage on intragastric pH of healthy volunteers / 中华消化杂志

Objective To evaluate the effect of csomeprazole with different dosage and usage regimes on intragastric pH of healthy volunteers. Methods It was a randomized, open-label, three-way crossover study. Fifteen healthy volunteers received esomeprazole with 3 different dosages (20 mg or 40 mg once daily or 20 mg twice daily) with 5 days each. Twenty-four continuous ambulatory intragastric pH was recorded at day 5 of each regime. Results The mean time of intragastric pH above 4 was higher in regime of 20 mg twice daily [(21.16 ±2.45) hours ] than that in regimes of 20 mg once daily [(18. 70±4.19) hours] and 40 mg once daily [(19.27±2.68 ) hours] (P<0.05). The percentages of the sleeping and active period that pH remained above 3,4,5 were significantly higher in regime of 20 mg twice daily(day time:95.0%±7.5% ,92.0%±10.6% ,86.7% ± 14.5% ;night time:93.2%± 13.1% ,87.8%±20.3% ,78.6%±28. 9 % )compared with regimes of 40 mg once daily(day time:87.9%±9.5% ,83.5%±11.7%,75.6%±15.50%, night time:75. 7%±20. 8%,66. 9%±23. 8%,53. 3%±30. 3%) and 20 mg once daily(day time: 85.1 % ± 16.3 %, 81.1 %± 18. 1%, 71.5 % ± 20.3 % ; night time: 72.9 % ± 30.5 %,67.2 % ± 31.9 %, 55.7 % ± 31.8 % ) (P< 0.05 ). Esomeprazole maintained intragastric pH above these pH thresholds for a similar propotion of sleeping and active periods with 40 mg once daily and 20 mg once daily.Conclusions Esomeprazole has strong inhibitory effect on intragastric acid. The regime of 20 mg twice daily is superior to 40 mg once daily and 20 mg once daily in both day and night time acid inhibition.There is no difference between esomeprazole 40 mg once daily and 20 mg once daily.

Value of combined multichannel intralumminal impedance-pH monitoring in the diagnosis of gastroesophageal reflux disease / 中华消化杂志

Objective To investigate the role of combined multichannel intralumminal impedanee-pH (MII-pH) monitoring in the diagnosis of gastroesophageal reflux disease (GERD). Methods Forty-four consecutive patients, who had heartburn symptom and without esophageal mucosal lesion, underwent combined MII-pH monitoring. Then rabeprazole test was performed for 14 days with 10 mg twice daily. Rabeprazole test was defined as positive if patients were totally heartburn symptom free in the second week. The normal values from 70 healthy volunteers who underwent MII-pH monitoring were served as controls. Results Conventional esophageal pH monitoring showed that 20 patients (45.5%) had pathologic esophageal acid exposure or positive acid reflux associated symptom index. MII-pH monitoring revealed that 2 patients were positive for weakly acidic reflux related to symptom index, thus increased the diagnostic yield to 50% (22/44). Furthermore, rabeprazole test demonstrated that 4 patients were positive which increased the diagnostic yield to 54.5%(24/44). Conclusion The detective rate of GERD will be elevated if combined with MII-pH monitoring in diagnosis.

Analysis for low scores in patients with reflux gastroesophageal disease using reflux diagnostic questionnaire / 中华消化杂志

Objective To analyse the clinical features of patients with gastroesophageal reflux disease(GERD)who had scores＜12 using reflux diagnostic questionnaires(RDQ).Methods A comparative and retrospective study was carried out in 148 GERD patients.Among whom 22 patients had low RDQ score(＜12)and 126 patients had high RDQ score(≥12).The differences in heart burn,substantial chest pain,regurgitation,severity and frequency of food reflux between two groups were compared.Nevertheless,the atypical symptoms such as chest distress.abnormal sensation of regurgitation or food reflux was significantly lower in patients with RDQ＜12 than those with RDQ≥accounted for 60.28%of the total RDQ score,whereas the heart burn,regurgitation and food reflux atypical symptom of chest distress was found in 13 patients(59.09%),abnormal sensation of throat in 8 patients(36.36%).cough and asthma in 3 patients(13.63%),headache in 5 patients(22.72%),belching in 9 patients(40.90%),aypnia in 8 patients(36.36%),and anxiety in 6 patients(27.27%).Conclusion RDQ is insensitive to those who have chest pain with no obvious symptom of heart burn,regurgitation or food reflux as well as those with atypical symptom beyond the RDQ.

The Diagnostic Strategy in Gastroesophageal Reflux Disease and the Role of Acid Inhibition Therapeutic Test / 中国医师杂志

14,and/or pH4% of the total time at 24-hour esophageal pH metry were considered to be pathologic acid reflux(GERD).All patients underwent a diagnostic test by receiving lansoprazloe 30mg or placebo twice daily for 7 days through a cross-over design.A symptom reduction of over 75% was considered positive.Results 18(17%) cases of esophagitis were found in 104 patients by endoscopy.83(80%) patients experienced a typical symptom hearburn.87(84%) patients showed pathologic acid reflux detected from pH metry and they were considered to be GERD.85(82%) of 104 patients had positive result in therapeutic test.There was a significant correlation between both the diagnosis obtained from a trial of lansoprazole and the diagnosis obtained from pH metry(P

Relationship between duodenogastric reflux and chronic inflammation of gastric mucosa / 中华消化杂志

0.05) for penetrating blood vessel, 46% and 18%( P

Gastric sensorimotor function in patients with functional dyspepsia / 中华消化杂志

0.05). Conclusions Gastric hypersensitivity, impaired proximal gastric accommodation and delayed gastric emptying may be important but independent pathophysiological factors of FD. Different pathophysiological factors can coexist in one patient with FD.

Ultrastructural investigation in esophageal mucosa of non-erosive gastroesophageal reflux disease / 中华消化杂志

Objective To explore the changes of ultrastructural characteristics including interstitial space dilation(ISD) and the number of desmosome in non-erosive gastroesophageal reflux disease(NERD)with abnormal and normal oesophageal acid exposure.Methods Nineteen patients with(abnormal) oesophageal acid exposure,20 with normal oesophageal acid exposure,10 with reflux(esophagitis)(RE) and 10 asymptomatic controls,classified on the basis of pH-metry,underwent(endoscopy.) Three biopsies were taken from the normal mucosa for light microscopy and transmission(electron microscopy) evaluation.ISD was measured and the number of desmosome in the intercellular spaces was calculated by using a digital scanner from photomicrographs of the specimens.The above two markers were compared with each other among the above groups.Results There was no significant difference in the mean score of the interstitial space between NERD and RE patients [(2.21?0.68)?m versus(2.39?0.42)?m,P0.05)].The mean score of the interstitial space of the control was(0.63(?0.21))?m,much lower than those of NERD and RE patients(P0.01).There was a significant(difference) in ISD between NERD with abnormal oesophageal acid exposure and normal oesophageal acid(exposure) [(2.45?0.67)?m versus(1.91?0.67)?m,P0.05].The mean numbers of desmosome in the intercellular space of the NERD and RE patients were(0.141?0.043) entries/?m~2 and(0.124(?0.044)) entries/?m~2,respectively,significantly lower than those of the controls [(0.221?0.031)(entries/?m~2].) But no significant differences were observed between the RE and the NERD patients(P0.05).Conclusions The interstitial space of esophageal mucosa in the NERD patients is dilated as in the RE.In NERD patients,the dilation of interstitial space is associated with abnormal acid exposure.The numbers of desmosome may also be a marker of esophageal mucosal injury of NERD.

Incidence of gastro-esophageal and-hypopharyngeal reflux during gynecological laparoscopy: laryngeal mask vs tracheal tube / 中华麻醉学杂志

Objective To compare the incidence of gastro-esophageal and -hypopharyngeal reflux during gynecological laparoscopy performed under general anesthesia and mechanical ventilation with tracheal intubation (TT) and laryngeal mask airway (LMA) .Methods Sixty ASA Ⅰ or Ⅱ patients aged 18-60 yrs with BMI 0.05 ) . Conclusion In low risk patients the incidence of gastro-esophageal regurgitation is comparable in patients undergoing gynecological laparoscopy in head-down position under general anesthesia and mechanical ventilation using either LMA or TT.