RESUMEN
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.
RESUMEN
Diseases of esophagus are common in gastroenterology practice. Improvement in diagnosis and better understanding in pathophysiology of these diseases have been possible recently due to advancement in technology. Advancement made in the field of computer softwares is another key development aiding further improvement in these instruments. In this article, we review techniques, interpretation and clinical utility of various tests of esophageal function with special reference to manometry, ambulatory pH and impedance monitoring. Esophageal manometry is simple to perform. Recent, availability of commercial user-friendly software has made analysis of recorded data easy. High resolution spatio-temporal manometry is advancement over conventional manometry. Manometry is a useful tool for diagnosis, followup and research in esophageal motility disorders. Ambulatory 24-h pH metry and impedance monitoring are also easily analyzed by commercially available software. 24-h impedance combined with pH-metry is currently considered as the gold standard for diagnosis of gastroesophageal reflux disease (GERD). All patients with GERD may not require these investigations, but those with atypical symptoms, those refractory to medical treatment and requiring surgery do. Esophageal transit study is useful in understanding functional correlates of abnormalities in manometry and is particularly useful during follow up studies and in research.