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Objectlve To review the clinical characteristics,esophageal motility and acid exposure in elderly patients with gastroesophageal reflux disease (GERD).Methods Two hundred and sixty patients aged 18 -81 years were diagnosed as gastroesophageal reflux disease from 2005 to 2011 in outpatient clinic,the patients were divided into elderly group ( ≥ 60 y) and control group ( ＜ 60 y).The incidence of esophagitis,severity of esophagitis,esophageal motility and esophageal acid exposure were analyzed and compared between two groups.Results The incidence of esophageal hiatal hernia,non-typical reflux symptoms and extra-esophageal symptoms in elderly group were higher than that of control group(45.1％ vs.30.6％,36.3％ vs.27.2％ and 37.1％ vs.25.2％,P =0.016,0.005 and 0.037,respectively).There was no significant difference in esophagitis incidence between two group (55.8％ vs.50.3％,P =0.250).The incidence of esophagitis graded as LA-B to LA-D were higher in elderly group( 19.5％ vs.10.2％ and 8.8％ vs.2.7％,P =0.034 and 0.030,respectively).The percentage of upright acid clearance time,supine reflux time of pH ＜4 and the DeMeester score of elderly group were higher than those of control group (P =0.000,0.006 and 0.001,respectively).Lower esophageal sphincter pressure (LESP) of elderly group was lower than that of control group ( 13.36 ±6.39 vs.15.57 ±7.01,P =0.009).Conclusion In comparison with young and middle-aged patients,the elderly GERD patients have lower esophageal motility,longer esophageal acid exposure time and higher frequency of severer esophagitis.
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ObjectiveTo investigate the characteristics of gastroesophageal reflux disease (GERD) with chronic cough by the results of combined multichannel intraluminal impedance and high-resolution manometry (MII-HRM) procedure and 24-hour muhichannel intraluminal impedance combined pH (MII pH) monitoring.Methods From March 2010 to November 2010,consecutive patients of GERD with chronic cough (more than 8 weeks) admitted to Beijing Chaoyang Hospital of Capital Medical University underwent 24-hour MII-pH monitoring and MII-HRM procedure with symptom association probability(SAP) over 95％.Data of lower esophageal sphincter (LES) pressure,LES relaxation,LES residual pressure,esophageal body peristalsis function and swallow bolus transit (liquid/viscous) was collected and the result of 24-hour MII-pH monitoring was analysed by the computer software containing reflux episode activity(acid/nonacid,upright/recumbent),proximal extent,acid exposure and mean acid/bolus clearance time.Seventeen patients of GERD with typical reflux symptom were selected as the control group.ResultsComparing with patients of GERD with typical reflux symptom,patients of GERD with chronic cough showeddecreased upper esophageal sphincter pressure (UESP) [( 122.55 ± 60.48 )mm Hg vs ( 86.37 ± 41.35 ) mm Hg,P ＜ 0.05,1 mm Hg =0.133 kPa ],higher percentage of abnormality peristalsis [(9.47 ± 15.63 ) ％ vs ( 22.16 ± 17.45 ) ％,P ＜ 0.05 ],degraded esophagus transmittability of liquid substance [( 88.82 ± 12.23) ％ vs ( 71.68 ± 23.06 ) ％,P ＜ 0.05 ],more reflux episode activity ( acid/nonacid ) in supine position and proximal reflux episode (nonacid) in supine position (P ＜ 0.05 )and longer mean bolus clearance time( P ＜ 0.05 ).Conclusion Decrease of the UESP,increase of the reflux episode activity (acid/nonacid) in supine position and proximal reflux episode (nonacid) in supine position,lengthened mean bolus clearance time in supine position and the degraded esophagus clearance ability may all correlated with the pathogenesy of GERD with chronic cough.
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Objective To determine the prevalence of gastroesophageal reflux disease (GERD) in patients with idiopathic pulmonary interstitial fibrosis (IPIF). Methods From December 2006 to January 2008, 24 consecutive patients with IPIF admitted to Beijing Chaoyang Hospital underwent 24-hour esophageal pH monitoring and esophageal manometry. Meanwhile, 23 patients with diffuse parenchymal lung disease (DPLD) (excluding IPIF) admired to the hospital in the same period served as a control group. Comparison of the prevalence of pathologic esophageal acid exposure GERD symptoms, and ineffective esophageal motility (IEM) between the two groups was made. In this study, nocturnal acid exposure is defined as acid reflux episodes occurring from 10pro to 6am. Results (1) 16 out of the 24 (66. 7%) patients with IPIF were demonstrated to have pathologic esophageal acid exposure; the prevalence of GERD in IPIF patients was significantly higher than that in other DPLD patients, whose prevalence was 26. 1% (P<0.05); (2) 87.5% patients with IPIF and GERD (GERD-IPIF) had nocturnal acid exposure episodes; (3) only 37.5% of the GERD-IPIF patients was found to have typical GERD symptoms such as heartburn and regurgitation; (4) The prevalence of IEM was similar in IPIF and other DPLD patients, being 42.9% and 39. 1% respectively (P >0. 05). Conclusions IPIF patients have higher prevalence of GERD and most of them usually do not show typical reflux symptoms. It is hereby suggested that IPIF patients should be screened with pH monitoring for GERD.
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Objective To investigate the manifestations of esophageal motility disorders and evaluate the association between them and dysphagia, laboratory tests and other accessory examinations in patients with Sj(o)gren's syndrome (SS). Methods Esophageal manometry was performed in 31 patients with SS and 18 healthy volunteers by the step pull-through method. Results Decreased upper esophageal sphincter pressure was detected in 19 of the 31 patients (61%) with SS, while 4 of 18 (22%) in controls. The frequency was significantly higher in patients than in healthy controls (P=0.008). Fifteen of 31 patients (48%) showed various patterns of esophageal dysfunction including ineffective esophageal motility in 6 patients, nutcracker esophagus in 3 patients and nonspecific dysmotility in 6 patients. No major differences were found in esophageal parameters (peak amplitude, wave duration and velocity) when comparing primary SS with secondary SS. These esophageal abnormalities were not correlated with clinical manifestations, laboratory examinations and other auxiliary examinations. Conclusion Patients with SS may have esophageal motility disorders, which can presents with different patterns.
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Objective To investigate the significance of changes of esophageal peristalsis in hiatal hernia patients. Methods 32 patients with symptom of gastroesophageal reflux(esophageal hernia 10, hiatal hernia with esophagitis 12 and esophagitis 10) and 9 patients without symptom of reflux were selected.Lower esophageal sphincter (LES) pressure ,esophageal peristaltic velocity ,amplitude and duration were detected respectively;the degree of esophagitis was identified with gastroscopy. Results LES pressures in hiatal hernia with esophagitis group and simple esophagitis group were significantly lower than those in control group , there was no significant difference between hiatal hernia group and control group . In hiatal hernia group ,the peristaltic amplitudes of proximal and distal esophagus (51.3?5.4 mmHg and 83.6?8.3 mmHg) were significantly higher than those in the other three groups , while esophagitis group was significantly the lowest . There were no significant difference about esophageal peristltic duration both of proxmial and distal esophagus between these four groups .Furthermore , distal esophageal peristaltic velocity was significantly higher in hiatal hernia group than that in the other three groups , and it was the lowest in esophagitis group .Conclusion The changes of esophageal peristalsis in patient with hiatal hernia play an important role in the pathogenesis of gastroesophageal reflux and mucosal injury.[
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Objective To detect the characteristics of NE patients with GERD.Methods All the 36 NE patients were divided into two groups:GERD group(11 patients)and non-GERD group(25 patients).Their clinical features and manometric findings were compaired.Results There were significant differences between the two groups in the parameters of 24 h pH monitoring and LES relaxation rate(P0.05).The difference of DeMeester score had statistical significance.Conclusion To properly diagnose the NE patients with reflux,we should consider not only clinical characteristics but also the result of 24 h pH monitoring and esophageal manometry.
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Objective To observe the type and prevalence of esophageal motility abnormality in patients with respiratory symptom.And to investigate the effect and clinical significance of ineffective esophageal motility(IEM)in the pathogenesis of GERD with respiratory symptom.Methods In the thirty-four GERD patients with respiratory symptoms of asthma,chronic cough,complaint of laryngeal pharynges,the esophageal manometry and 24 hour esophageal pH monitoring were performed by Multiple Functional Gastrointestinal Motility Monitor made by MMS,Holland.The peristaltic velocity,amplitude and duration of esophageal body and lower esophageal sphincter(LES)pressure was detected.Computer software was used to analyze pH monitoring result,including the percentage of pH0.05)between GERD patients with respiratory symptom group and normal control group.In the group of GERD patients with respiratory symptom,main abnormal esophageal motility type was IEM,the prevalance of IEM(41.2%)being significantly higher than that in group of typical reflux symptom GERD(18.5%)and normal control group(0).In 34 GERD patients with respiratory symptom,24 hour esophageal pH monitoring result of IEM group and normal esophageal motility group was analyzed:the total percentage of pH
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In order to investigate the relationship between gastric juice ammonia concentrations and severity of inflammation in helicobacter pylori (Hp ) associated gastritis. Gastric juice ammonia concen- trations were measured in 39 cases Hp -positive and 23 cases Hp -negative chronic gastritis patients .at the same time , the severity of inflammation in gastric untral mucosa was also evaluataed by the method of polymorphonuclear (PMN) and mononuclear (MN ) count. The results showed : gastric juice ammonia concentration in Hp -- positive gastritis group (84.10?33. 07mg/L)was significantly higher than that in the negative group (22. 59?13. 12mg/L) (P