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INTRODUCTION: High-resolution esophageal manometry (HREM) is a technique to determine the pressure pattern which is a function of esophageal musculature and integrity of LES. The indications for HREM evaluation include evaluation of nonobstructive dysphagia, symptoms of regurgitation and noncardiac or atypical chest pain unexplained by endoscopic evaluation To analyse profile of esophageal motility disorders in patient presenting with refractoryAIM: gastroesophageal reflux disease (GERD), dysphagia and atypical chest pain in tertiary care centre in Western India METHODS: We enrolled patient presented with refractory GERD, dysphagia and atypical chest pain from Jan 2020 to March 2022 at Department of gastroenterology, National Institute of Medical College & R, Jaipur. Upper GI endoscopy and high-resolution esophageal manometry was done in all patients Ineffective esophageal peristalsis,RESULTS: achalasia cardia, hypercontractile esophagus, fragmented peristalsis and esophagogastric junction outflow obstruction were common diagnosis made by high resolution esophageal manometry In our study ineffectiveConclusion: esophageal motility most common and achalasia cardia second most common diagnosis identified on esophageal manometry
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Objective:To establish the normal values of water-perfused high resolution esophageal manometry (HREM)(GAP-36A) at resting period, water swallowing, semisolid swallowing and solid swallowing in Chinese population.Methods:From September 1, 2019 to June 30, 2020, 91 healthy volunteers receiving water-perfused HREM (GAP-36A) at resting period, water swallowing, semisolid swallowing and solid swallowing were selected from 9 hospitals (Union Hospital, Tongji Medical College, Huazhong University of Science and Technology; the First Affiliated Hospital of Dalian Medical University; the Second Hospital of Hebei Medical University; the Second Affiliated Hospital, Naval Medical University; the First Affiliated Hospital, Sun Yat-sen University; the First Affiliated Hospital, University of Science and Technology of China; Aviation General Hospital of China Medical University; the Affiliated Hospital of Medical School of Nanjing University and the First People′s Hospital of Yichang). Parameters included the position of the upper and lower edges of the upper esophageal sphincter (UES) and lower esophageal sphincter (LES), the length of the LES and UES, the position of the pressure inversion point (PIP), the resting pressure of UES and LES and swallow-related parameters such as the distal contraction integral (DCI), 4 s integrated relaxation pressure (IRP), distal latency (DL) and UES residual pressure. One-way analysis of variance, post-hoc test and sum rank test were used for statistical analysis.Results:A total of 87 healthy volunteers were enrolled, including 40 males and 47 females, aged (38.5±14.2) years old (ranged from 19 to 65 years old). The position of the upper and lower edges of the LES was (42.7±2.8) and (45.6±2.8) cm, respectively, the length of the LES was (2.9±0.4) cm, and the position of PIP was (43.3±2.8) cm. The position of the upper and lower edges of the UES was (18.1±3.0) and (22.6±2.0) cm, respectively, and the length of the UES was (4.8±1.0) cm. The resting pressure of LES and UES was (17.4±10.7) and (84.1±61.1) mmHg (1 mmHg=0.133 kPa), respectively. The DCI value at solid swallowing was higher than those at water swallowing and semisolid swallowing ((2 512.4±1 448.0) mmHg·s·cm vs. (2 183.2±1 441.2) and (2 150.8±1 244.8) mmHg·s·cm), and the differences were statistically significant ( t=-4.30 and -3.74, both P<0.001). The values of 4 s IRP at semisolid swallowing and solid swallowing were lower than that at water swallowing ((4.6±4.1) and (4.9±3.9) mmHg vs. (5.4±3.9) mmHg), and the differences were statistically significant ( t=3.38 and 2.09, P=0.001 and 0.037). The DL at water swallowing was shorter than those at semisolid swallowing and solid swallowing ((8.5±1.8) s vs. (9.8±2.2) and (10.6±2.8) s), and the DL at semisolid swallowing was shorter than that at solid swallowing, and the differences were statistically significant ( t=-10.21, -13.91 and -4.68, all P<0.001). The UES residual pressure at water swallowing was higher than those at semisolid swallowing and solid swallowing (9.5 mmHg, 6.5 to 12.3 mmHg vs. 8.0 mmHg, 4.5 to 11.7 mmHg and 5.5 mmHg, 2.0 to 9.3 mmHg), and the UES residual pressure at semisolid swallowing was higher than that at solid swallowing, and the differences were statistically significant ( t=3.48, 10.30 and 6.35, all P<0.001). Conclusions:The normal values of water-perfused HREM (GAP-36A) in Chinese population at resting period, water swallowing, semisolid swallowing and solid swallowing can provide a reference basis for clinical diagnosis and treatment for patients receiving water-perfused HREM examination.
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RESUMEN: Introducción: La manometría esofágica de alta resolución se considera a nivel internacional como un método óptimo para el diagnóstico de los trastornos motores del esófago, de alta especificidad y sensibilidad. Dada la reciente introducción de la técnica en Cuba, se necesita demostrar su utilidad en nuestro país, donde no existe grado de conocimiento previo sobre cuáles son los parámetros de normalidad, así como los diagnósticos de alta resolución más frecuentes. Objetivo: Determinar la utilidad de la manometría esofágica de alta resolución como estudio diagnóstico para los trastornos motores del esófago en Cuba. Métodos: Se diseñó una investigación aplicada, de desarrollo, realizada en el Centro Nacional de Cirugía de Mínimo Acceso, en La Habana, entre junio de 2017 y junio de 2019, en pacientes a los que se les realizó una manometría esofágica. El universo de pacientes fue 611, a quienes se les registraron las variables en estudio. Resultados: De las 611 manometrías esofágicas, 356 correspondían a mujeres (58,3 por ciento) y 255 a hombres (42,7 por ciento), con un promedio de edad de 47, 44 años respectivamente. La motilidad inefectiva fue el trastorno motor más frecuente (32,73 por ciento). En los pacientes con Enfermedad por Reflujo Gastroesofágico, el principal daño de la barrera antirreflujo fue la presencia de relajaciones transitorias del esfínter esofágico inferior. Predominó la Acalasia tipo II (5,23 por ciento). En estos pacientes se registraron valores de Presión de relajación integrada (IRP) por encima de 21. Conclusiones: Se establecieron valores aplicables a pacientes cubanos, que permiten establecer el diagnóstico por alta resolución(AU)
ABSTRACT Introduction: High-resolution esophageal manometry is considered internationally as an optimal method for diagnosis of esophageal motor disorders. Given the recent introduction of the technique in Cuba, it is necessary to demonstrate its usefulness in our country where there is no prior knowledge about the most frequent parameters of normality and high resolution diagnoses. Objective: To determine the usefulness of high-resolution esophageal manometry as a method for the diagnosis of esophageal motor disorders in Cuba. Material and methods: An applied developmental research was designed and carried out at the National Center for Minimal Access Surgery in Havana between June 2017 and June 2019. The study included patients in whom esophageal manometry was performed. The universe consisted of 611 patients and the variables used in the study were recorded. Results: Of the 611 patients who underwent esophageal manometry, 356 were women (58.26 percent) and 255 were men (42.73 percent), with an average age of 47 and 44 years, respectively. Ineffective motility was the most frequent motor disorder (32,73 percent). In patients with Gastroesophageal Reflux Disease, the main damage of the antireflux barrier was the presence of transient lower esophageal sphincter relaxations. Type II achalasia predominated (5,23 percent). In these patients, integrated relaxation pressure (IRP) values above 21 were recorded. Conclusions: Values applicable to Cuban patients that allow to establish a high-resolution diagnosis were established(AU)
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Humans , Esophageal Motility Disorders/diagnosis , Manometry/methods , CubaABSTRACT
Objective To investigate the symptom,esophageal motility characteristics and the prevalence of gastroesophageal reflux disease(GERD)in patients with typeⅠ,Ⅱand Ⅲ gastroesophageal junction (EGJ)diagnosed by high resolution esophageal manometry(HREM).Methods From 6th January to 27th December in 2012,the clinical data of 171 patients with reflux symptoms and received HREM were retrospectively analyzed.According to the Chicago classification V.3.0,the patients were divided into EGJ type Ⅰ,Ⅱ and Ⅲ groups.The age,body mass index(BMI),GERD related symptoms,esophageal motility parameters and the incidence of GERD were compared among the three groups.Chi-square test, t test and analysis of variance were used for statistical analysis.Relationship between EGJ types and other variables were analyzed by Spearman rank correlation.Results In 171 patients,136 cases(79.5%)with type Ⅰ EGJ,22 cases(12.9%)with type Ⅱ EGJ and 13 cases(7.6%)with type Ⅲ EGJ.The age of patients with type Ⅱ EGJ was significantly older than that of patients with type Ⅰ EGJ((56.5 ± 2.3) years vs(48.6 ± 1.0)years,t=2.992,P=0.003),however the differences were not statisticant when compared with type Ⅲ EGJ patients((51.2 ± 3.8)years,P> 0.05).The BMI of patients with typeⅢ EGJ was higher than that of typeⅠand typeⅡEGJ patients((26.0 ± 1.3)kg/m2vs(21.9 ± 0.3)kg/m2and (23.5 ± 0.6)kg/m2),and the difference was statistically significant(t=4.082 and 2.108,both P<0.05). The resting pressure of lower esophageal sphincter(LES)of patients with type Ⅱ and Ⅲ EGJ were lower than that of typeⅠEGJ((10.6 ± 1.5)mmHg(1 mmHg=0.133 kPa)and(3.4 ± 0.7)mmHg vs(17.1 ± 0.7)mmHg),and the resting pressure of LES of type Ⅲ EGJ was lower than that of type Ⅱ EGJ((3.4 ± 0.7)mmHg vs(10.6 ± 1.5)mmHg),and the differences were all statistically significant(t= -3.882,-6.411 and -2.769,all P< 0.01).The amplitude of contraction at 11 cm above LES and distal contractile integral(DCI)of patients with type Ⅲ EGJ were both lower than those of patients with typeⅠ EGJ((32.2 ± 5.4)mmHg vs(48.5 ± 2.5)mmHg,and(392.0 ± 94.1)mmHg·s·cm vs(805.1 ± 61.4)mmHg·s·cm),and the differences were statistically significant(t= -2.580 and -2.041,both P<0.05).The incidences of GERD in patients with type Ⅰ,Ⅱ and Ⅲ EGJ were 68.4%(93/136), 77.3%(17/22)and 10/13,respectively,and the difference was not statistically significant(χ2 =1.021, P=0.600).EGJ types were positively correlated with age and BMI(r= 0.214 and 0.290,both P<0.01).However,EGJ types were negatively correlated with the LES resting pressure,contraction amplitudes at 7 cm and 11 cm above the LES,and DCI(r= -0.474,-0.182,-0.333 and -0.191,all P<0.05).Conclusions Aging,overweight and obesity are risk factors of the LES and crural diaphragm separation.EGJ types are not predictable based on symptoms.The esophageal motility seems to decrease in patients with type Ⅱ and Ⅲ EGJ,the incidence of GERD in patients with type Ⅰ,Ⅱ and Ⅲ EGJ are all high.
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Objective:To analyze the monitoring results of high resolution esophageal manometry (HRM) and 24-Hour impedance-pH for the patients with functional heartburn (FH)and non-erosive reflux disease(NERD), and explore the effect of Gastroesophageal junction morphology, transient lower esophageal sphincter relaxation and regurgitation of gastric acid in FH and NERD.Methods: 86 patients with continuous heartburn who were negative under endoscope were divided into FH group(38cases) and NERD group(48cases), and gastrointestinal symptom rating scales (GSRS), the results of HRM and 24h pH/impedance monitoring of the two groups were compared and analyzed.Results: The GSRS of sour regurgitation, abdominal distension, diarrhea and constipation of FH group were significantly higher than that of NERD group, respectively(t=-4.45,t=3.83,t=3.07,t=4.58,P<0.05). The ratio of esophagogastric junction-III(EGJ-III)of FH group was significantly lower than that of NERD group (Z=-3.27,P<0.05). And the ratio of esophageal hiatus hernia of FH group was significantly lower than that of NERD group(x2=16.01,P<0.05). In HRM parameters, the differences of lower esophageal sphincter pressure (LESP), upper esophageal sphincter pressure(UESP), distal contractile integral(DCI)and esophagogastric junction- contractile integral (EGJ-CI) between FH group and NERD group were statistically significant(t=6.99,t=-4.51,t=-2.91,t=-3.72;P<0.05), respectively. On the other hand, the times of sour regurgitation in erect position, the ratio of fluid regurgitation, exposed time of erect position and clinostatism, and DeMeester integral of NERD group was statistically significant higher than that of FH group(t=-9.48,t=-13.00,t=-13.56,t=-18.31;P<0.05).Conclusion:There are esophageal dysfunction in a certain degree and obvious regurgitation in both of two groups, and the detections of HRM and 24h-impedance pH contribute to differential diagnosis for NERG. Besides, the symptom of patients with FH may be relative with regurgitation of non-acidic material, especially may be relative with regurgitation of air.
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Objective To analyze the effects of different food bolus on esophageal motility in patients with non-obstructive esophageal dyshagia by high-resolution esophageal manometry.Methods From March 2014 to June 2015,48 patients with non-obstructive esophageal dysphagia and 12 healthy volunteers (healthy control group) were enrolled.High-resolution manometry was tested when swallowing liquid food,semisolid food and solid food.The lower esophageal sphincter pressure (LESP),4 second integrated relaxation pressure (4 s IRP),distal contractile integral (DCI),distal latency (DL),and breaks were analyzed.T test was performed for statistical analysis.Results According to the 2014 Chicago classification standard,among 48 patients with dysphagia,esophageal dysmotility was diagnosed in 35 patients (72.9％),while 13 patients (27.1％) had normal esophageal motility,and the most common type of esophageal motility disorder was ineffective esophageal motility (31.2％,15/48).The LESP of the healthy control group was (10.85±3.75) mmHg (1 mmHg=0.133 kPa) and 4 s IRP was (1.90±0.84) mmHg.The LESP of dysphagia group was (12.20 ±8.93) mmHg and 4 s IRP was (3.25± 1.02) mmHg.There was no significant difference in LESP and 4 s IRP between two groups (both P＞0.05).The DCIs of liq(u)id swallows,semisolid swallows and solid swallows of healthy control group were (589.00±292.90),(690.17±52.41) and (808.00±448.53) mmHg · s · cm,respectively,which were significantly lower than those of complete normal group in Chicago classification ((1 346.62 ± 244.83),(1 542.46±231.19) and (1 890.31±363.26) mmHg · s · cm;t=4.76,4.68 and 3.79;all P=0.001).The DL of solid swallows of healthy control group was (7.72± 1.15) s,which was significantly lower than that of complete normal group in Chicago classification ((9.00±1.23) s;t=2.61,P=0.021).The breaks of liquid swallows,semisolid swallows and solid swallows of healthy control group were (2.33 ±1.74),(2.37±1.72) and (1.53± 1.22) cm,respectively,which were higher than those of complete normal group in Chicago classification ((0.58±0.48),(0.52±0.47) and (0.85±0.53) cm),and the differences were statistically significant (t =3.02,3.68 and 2.54,all P ＜ 0.05).Conclusions The most common type of esophageal motility disorder in patients with non-obstructive esophageal dysphagia is ineffective esophageal molitity.When swallowing food,the patients with dysphagia but normal results of esophageal manometry according to Chicago classification require more strength of the esophagus,more complete contraction and longer peristaltic time to swallow food bolus.
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Resumen Con la introducción de la manometría esofágica de alta resolución se revelaron patrones no identificados previamente de la función esofágica. De igual forma, este método diagnóstico adiciona patrones de presión topográfica de la presión esofágica, lo que lleva al desarrollo de nuevas herramientas para el análisis y clasificación de desórdenes motores esofágicos. En la actualidad, la clasificación de Chicago 3.0 es la herramienta de análisis de los diferentes trastornos motores esofágicos. En Colombia, cada día se ve el crecimiento en la realización de este estudio. El artículo propone hacer una revisión de cómo realizar e interpretar una manometría esofágica de alta resolución y clasificar los diferentes trastornos de la motilidad esofágica según la última actualización de la clasificación de Chicago 3.0.
Abstract The introduction of high resolution esophageal manometry has led to the revelation of previously unidentified patterns of esophageal function. Similarly, this diagnostic method has revealed topographic patterns of esophageal pressure which has led to the development of new tools for analysis and classification of esophageal motility disorders. Currently, the Chicago 3.0 classification has become a tool for analysis of the various esophageal motility disorders. In Colombia, the use of this study is spreading and growing. This article reviews of how to perform and interpret high resolution esophageal manometry and shows how to classify esophageal motility disorders according to the latest update of Chicago 3.0.
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Esophageal Achalasia , Manometry , Gastrointestinal MotilityABSTRACT
El esófago en martillo neumático (Jackhammer) es un trastorno peristáltico de hipercontractilidad, que de acuerdo con la clasificación de Chicago v.2 se define manométricamente como la presencia de una onda de amplitud y velocidad alta; es decir, con una integral de contractibilidad distal (ICD) superior a 8000 mm Hg/cm/s. Presentamos una serie de cinco pacientes con esófago en martillo neumático que fueron estudiados con manometría esofágica de alta resolución (MAR); recopilamos sus variables clínicas y manométricas. Los casos correspondieron a tres hombres y dos mujeres entre 41 y 73 años de edad. En 3 de ellos se había realizado el diagnóstico de enfermedad por reflujo gastroesofágico, y presentaban síntomas de disfagia, pirosis y regurgitación. El principal hallazgo endoscópico fue la presencia de una hernia hiatal y presbiesófago (2 de 5 pacientes). En todos ellos se realizó MAR que demostró la presencia de una y hasta 4 ondas con ICD superior a 8000 mm Hg/cm/s. Además, la presencia de ondas multipico en 3 de los 5 pacientes, aunque, de acuerdo con la nueva clasificación de Chicago v.3, se requiere la presencia de dos ondas con ICD superior a 8.000 mm Hg/cm/s. Se debe resaltar que aún no se cuenta con equipos disponibles que interpreten a MAR y permitan clasificar los trastornos esofágicos por Chicago v.3, y es por esto que en nuestra unidad de fisiología aún reportamos la MAR con la clasificación previa. Concluimos que el esófago en martillo neumático es una patología con clínica variada que va desde disfagia y dolor torácico hasta síntomas por ERGE, cuyo diagnóstico debe ser confirmado por MAR
Jackhammer esophagus is a peristaltic hypercontractile disorder. According to the second version of the Chicago Classification of esophageal motility, jackhammer esophagus is defined manometrically by distal contractile integrals greater than 8000 mm Hg/cm/s which indicates very high amplitude and velocity. We present a series of five patients with jackhammer esophagus who underwent high-resolution esophageal manometry (HREM) from which clinical and manometric data were collected. There were three men and two women whose ages ranged from 41 to 73. Three of them had been diagnosed with gastroesophageal reflux disease, and showed symptoms of dysphagia, heartburn and regurgitation. The main endoscopic finding was the presence of hiatal hernia and presbyesophagus in two patients. HREM showed waves of up to 4 mm Hg greater than 8000 mm Hg/cm/s. In three of the five patients there were multiple waves. Although, the new third version of the Chicago classification of requires two waves with DCIs over 8000 mm Hg/cm/s to confirm a diagnosis of jackhammer esophagus, it should be noted that we do not yet have available equipment to interpret MAR and allow classifying esophageal disorders by Chicago v.3, and that is why in our physiology unit we still report the MAR with presorting. We conclude that the jackhammer esophagus is a disease with a varied clinical presentation that ranges from dysphagia and chest pain to GERD symptoms. Diagnosis must be confirmed by HREM
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Humans , Male , Female , Adult , Esophageal Diseases , ManometryABSTRACT
Objective To investigate esophageal motility characteristics in gastroesophageal reflux disease (GERD) patients with or without dysphagia by high-resolution manometry and 24 h esophageal pH monitoring.Methods From August 2012 to November 2015,GERD patients with symptoms of acid reflux and heart burn who received 24 h esophageal pH monitoring were collected.The differences in esophageal motility were further analyzed between the GERD patients with dysphagia and without dysphagia.Student's t test,x2 test and Fisher's exact test were performed for comparison analysis.Results A total of 194 patients received 24 h esophageal pH monitoring and diagnosed as GERD,and at the same period completed esophageal high-resolution manometry.Among them,there were 17 GERD patients (8.8％) with dysphagia and 177 patients (91.2％) without dysphagia.The main classification of esophageal motility disorder of GERD patients with dysphagia was severe esophageal motility disorders (5/ 17),but the motility type of GERD patients without dysphagia patients mainly was mild esophageal motility disorders (10.2％,18/177).The integrated relaxation pressure,residual pressure of lower esophageal sphincter (LES),and contraction range at 3 cm and 11 cm above LES of GERD patients with dysphagia were all higher than those of patients without dysphagia ((9.70±0.98) mmHg (1 mmHg=0.133 kPa) vs (7.02±0.30) mmHg,(12.75±1.35) mmHg vs (9.18±0.42) mmHg,(106.80± 11.97) mmHg vs (70.82±3.48) mmHg,(82.66±10.70) mmHg vs (56.93±3.11) mmHg),and the differences were statistically significant (t=2.601,2.488,2.887,2.308,all P＜0.05).Distal esophageal contraction integral score of GERD patients with dysphagia was significantly higher than that of GERD patients without dysphagia ((2 128.94±310.47) mmHg · cm · s vs (1 029.88±90.16) mmHg · cm · s),and the difference was statistically significant (t =3.400,P =0.001).However,residual pressure of upper esophageal sphincter was significantly lower than that of patients without dysphagia ((2.84±1.21) mmHg vs (6.18±0.38) mmHg,t=-2.650,P=0.009).Conclusions Esophageal motility disorder of GERD patients with dysphagia is severer than that of patients without dysphagia.High resolution esophageal manometry can provide objective evidence of esophageal dynamics of GERD patients,which can guide the diagnosis and treatment of GERD.
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Objective To investigate upper esophageal sphincter (UES)abnormalities in patients with achalasia (AC),and to analyze the correlation between UES abnormalities and clinical symptoms, treatment efficacy.Methods From February 2012 to December 2014,158 patients with AC and received high resolution manometry (HRM)examination were retrospectivly analyzed.According to whether with UES abnormalities,patients were divided into UES normal group and UES abnormal group.Patients of UES abnormal group were sub-divided into UES hypotensive group (UES resting pressure104 mmHg)and impaired relaxation group (residual pressure>12 mmHg).Analysis of Variance,Kruskal-Wallis H test and Chi square test were performed to compare the clinical data and dynamic characteristics of the patients in each group. Results A total of 74 (46.8%)AC patients had UES abnormalities,the majority of whom were impaired relaxation (35 cases,47.3%).The age of patients in hypotensive group ((60.6 ± 10.1 )years)was significantly older than that of hypertensive group ((43.9 ±11 .1 )years)and impaired relaxation group ((46.8±16.3)years),and the disease course (10 years,4 to 30 years)was obviously longer than that of hypertensive group (6 years,1 to 10 years)and impaired relaxation group (8 years,3 to 15 years),and the differences were statistically significant (F = 7.983,H = 13.816,both P 0.05 ).The results of AC subtyping indicated that type Ⅱ AC accounted 55 .7% (88/158).Type Ⅱ AC cases number of UES normal group and abnormal group was 46 and 42 cases,both was majority (54.8% and 56.8%).Among these patients,123 patients finally received peroral endoscopic myotomy (POEM),47.2%(58/123 )of whom had abnormal UES.More than 85 % patients were satisfied at one month after the operation.And Eckardt scores significantly decreased.There was no significant difference in treatment efficacy between the two groups.Conclusions Most AC patients are with UES abnormality,and impaired relaxation is more common.There is no correlation between UES abnormalities and major symptoms.There is no predictive role of UES abnormalities in treatment efficacy of POEM in AC patients.
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Objective To investigate the effects of acupuncture on the improvement of esophageal motility disorder in patients with refractory gastroesophageal reflux disease (GERD).Methods From September 2012 to March 2014,40 patients with refractory GERD were enrolled and evenly divided into the treatment group and the control group. High resolution esophageal impedance manometry was conducted in patients.After the first examination,patients of the control group lay down for 30 minutes, and patients of the treatment group received acupuncture treatment at Neiguan,Gongsun and Zusanli points for 30 minutes.Then all the patients underwent high resolution esophageal impedance manometry again.ManoView ESO 3.0 software was used for analysis.The parameters included swallowing peristalsis defect,lower esophageal sphincter (LES)pressure,LES residual pressure,LES length,upper esophageal sphincter (UES)pressure,distal wave amplitude,peristalsis duration time,starting speed of peristalsis wave,speed of edge contraction and integration of the peristaltic waves.Chi-square test or t test was performed for data analysis.Results The percentage of normal swallows of the treatment group before and after treatment was 56.0% (112/200)and 74.0% (148/200),the percentage of delayed esophageal emptying was 31 .5 % (63/200 )and 11 .5 % (23/200 ),and the differences were statistically significant (χ2 =14.242 and 23.700,both P 0.05 ).The LES resting pressure of the treatment group before and after treatment was (20.2 ±18.8)mmHg (1 mmHg=0.133 kPa)and (26.3±10.1)mmHg,the length of LES was (2.2 ±0.6 )cm and (3.3 ±0.8)cm,the distal esophageal peristaltic amplitude was (60.2 ± 21 .9)mmHg and (41 .1 ± 16.8 )mmHg,and the differences were statistically significant (t = 5 .519, 6.580 and 6.881 ,all P 0.05 ).There as no significant difference in LES resting pressure and LES residual pressure of the control group before and after lying down (both P >0.05 ).However,before and after lying down,there were significant differences in the length of LES ((2.3 ±0.6)cm vs (2.5 ±0.6)cm) and UES resting pressure ((67.4 ±21 .2 )mmHg vs (53.5 ±18.1 )mmHg)in the control group (t =2.530 and 6.652,both P 0.05).Before and after lying down,there was no significant difference in distal wave amplitude,duration of peristalsis,the beginning speed of the peristaltic wave and CFV of the control group (all P >0.05 ).Conclusion Acupuncture can help increase the LES resting pressure,extend the length of LES,improve the overall peristaltic pressure and completeness of esophageal somatic part,meanwhile,it increases the percentage of normal swallows of patients with refractory GERD.