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【Objective】 To explore the characteristics of esophageal motility and reflux of endoscopic-negative heartburn patients based on the Lyon Consensus Diagnostic Criteria and discuss the differential diagnosis value of the mean nocturnal baseline impedance （MNBI） and the postreflux swallow-induced peristaltic wave （PSPW） index for reflux hypersensitivity （RH） and functional heartburn （FH） patients. 【Methods】 We enrolled 132 patients with heartburn as the main symptom who visited the Gastroenterology Department of our hospital from January 2017 to June 2021， including 24 in the non-erosive reflux disease （NERD） group， 24 in the RH group， and 84 in the FH group. All the patients completed gastroscopy， esophageal high-resolution manometry and 24h-pH impedance monitoring. We analyzed and compared the related indexes of esophageal motility and reflux. The receiver operating characteristic （ROC） curve was used to analyze the esophageal proximal MNBI， distal MNBI， and PSPW indexes for the differential diagnosis of RH and FH. 【Results】 The lower esophageal sphincter （LES） average resting pressure， LES residual pressure and intact relaxation pressure （IRP） in NERD were lower than those in RH and FH （P0.05）. When the proximal MNBI， distal MNBI， and PSPW indexes were used alone respectively to diagnose RH， the area under the ROC curve was 0.480， 0.810， 0.682， respectively， with the sensitivities being 87.5%， 100% and 91.7%， and the specificities being 26.2%， 66.7% and 51.2%， respectively. 【Conclusion】 NERD patients have obvious abnormal esophageal dynamics， mainly manifested as LES relaxation， which further aggravates the pathological acid reflux， while patients with RH and FH are mainly exposed to physiological acid or non-acid reflux. In patients with endoscopic negative heartburn， distal MNBI value can improve the clinical diagnosis rate of RH and help distinguish RH from FH.
RESUMO
Objective:To investigate the clinical features, diagnosis, treatment and prognosis of gastrointestinal neurilemmoma.Methods:A descriptive study was conducted to retrospectively analyze the clinical manifestations, endoscopic findings, pathological features, treatment methods and prognosis of patients with gastrointestinal neurilemmima diagnosed from May 2017 to November 2020 in the Second Affiliated Hospital of Xi'an Jiaotong UniversityResults:A total of 19 patients were collected, ranging in age from 45.0 to 70.0 years old, of whom 68.4% (13/19) were female. The clinical symptoms are non-specific, and some patients are asymptomatic (15.8%(3/19)) and may present with abdominal pain (57.9%(11/19)), nausea (31.6%(6/19)), abdominal distension (21.1%(4/19)) and decreased appetite (21.1%(4/19)), and a few with gastrointestinal bleeding (5.3%(1/19)). Tumors were most frequently found in the gastric body (42.1%(8/19)), followed by the duodenum (15.8%(3/19)). Endoscopic submucosal mass is easy to be misdiagnosed as stromal tumor. The pathological type showed shuttle cell tumor, immunohistochemical staining showed positive S100 and Vim, most Ki-67 staining proliferation rate was <5% (57.9%(11/19)), and a small part was ≥10% (10.5%(2/19)). Treatment was either endoscopic or surgical. No tendency to recur and metastasize was found in any of the neurilemmimas.Conclusion:Gastrointestinal neurilemmoma is a very rare submucosal tumor of the digestive tract, most of which are benign and rare in malignancy, and postoperative pathology is the gold standard for its diagnosis. Gastrointestinal neurilemmoma is common in middle-aged female, with diverse and non-specific clinical symptoms, difficult to differentiate from submucosal tumors such as stromal tumors, and its tendency to malignant transformation increases with tumor enlargement. Endoscopic resection is recommended for tumors with tumor diameter <3 cm without serosal invasion, with little trauma and no recurrence.