Clinical significance of ineffective esophageal motility in non-erosive acid reflux diseases / 中华消化内镜杂志

Objective:To investigate the role of ineffective esophageal motility (IEM) in non-erosive acid reflux related diseases, and the influence of the fourth edition Chicago classification (CC v4.0) on the diagnosis of IEM.Methods:From January 2018 to January 2020, 63 patients with acid reflux related symptoms who underwent gastroscopy and showed no abnormal changes in esophageal mucosa or structure, and underwent high resolution esophageal manometry (HRM) and 24-hour esophageal pH monitoring in the Department of Gastroenterology of Beijing Friendship Hospital were included in the case-control study. According to the HRM results, the third edition Chicago classification standard (CC v3.0) and CC v4.0 were used to divided patients into IEM group and normal dynamic group. The HRM results, 24-hour esophageal pH monitoring results and final diagnosis of the two groups under the two editions of Chicago classification standard were mainly compared and analyzed.Results:Among the 63 patients, there were 14 cases of non-erosive gastroesophageal reflux disease (NERD), 19 cases of reflux hypersensitivity (RH), and 30 cases of functional heartburn (FH). When using CC v3.0, there were 20 cases in the IEM group, including 9 cases of NERD, 5 cases of RH and 6 cases of FH, and 43 cases in the normal dynamic group, including 5 cases of NERD, 14 cases of RH and 24 cases of FH. When using CC v4.0, there were 16 cases in the IEM group, including 7 cases of NERD, 4 cases of RH and 5 cases of FH, and 47 cases in the normal dynamic group, including 7 cases of NERD, 15 cases of RH and 25 cases of FH. When using CC v3.0, compared with the normal dynamic group, the acid exposure time (AET) of the IEM group was significantly higher [3.45 (1.55, 6.40)% VS 1.20 (0.40, 2.30)%, Z=-2.940, P=0.003], the DeMeester score was also significantly higher [13.8 (5.8, 21.4) VS 5.3 (2.9, 10.0), Z=-2.851, P=0.004], the lower esophageal sphincter pressure (LESP) [10.15 (7.52, 13.65) mmHg (1 mmHg=0.133 kPa) VS 15.40 (11.20, 21.60) mmHg, Z=-3.241, P=0.001], 4-second integrated relaxation pressure (4sIRP) (3.79±0.57 mmHg VS 6.05±0.50 mmHg, t=2.727, P=0.008), and distal contraction integral (DCI) [334.65 (208.25, 438.92) mmHg·s·cm VS 1 258.70 (919.00, 1 750.10) mmHg·s·cm, Z=-6.305, P<0.001] were significantly lower than those of the normal dynamic group. When using CC v4.0, AET and Demeester scores in the IEM group were also significantly higher than those in the normal dynamic group (both P<0.05), and LESP, 4sIRP and DCI were also significantly lower than those in the normal dynamic group (all P<0.05). In addition, upper esophageal sphincter pressure was significantly lower than that in normal dynamic group [34.60 (21.50, 48.05) mmHg VS 49.67 (36.75, 61.10) mmHg, Z=-2.140, P=0.032]. Conclusion:IEM is associated with impaired anti-reflux barrier function and esophageal acid exposure in patients with non-erosive acid reflux related diseases. Compared with CC v3.0, CC v4.0 can reduce the heterogeneity of IEM patients to some extent.

Clinical efficacy and safety of rabeprazole in combined with flupentixol melitracen in treatment of non -erosive gastroesophageal reflux disease with anxiety and depression / 中国基层医药

Objective To explore the clinical efficacy and safety of rabeprazole in combined with flupentixol melitracen in treatment of non -erosive gastroesophageal reflux disease with anxiety and depression.Methods 84 cases with non -erosive gastroesophageal reflux disease with anxiety and depression of outpatient and inpatient admitted from October 2012 -October 2013 and they were randomly divided into two groups according to the order,all had 42 cases.The control group was given rabeprazole treatment,observation group used flupentixol melitracen treat-ment on the basis of the control group.The clinical efficacy and the occurrence of adverse reactions of the two groups were compared.Results The total effective rate of the observation group was 95.24%,which was significantly higher than 76.19% in the control group,the difference was significant (χ2 =11.20,P 0.05 ).Conclusion Rabe-prazole in combined with flupentixol melitracen in treatment of non -erosive gastroesophageal reflux disease with anxi-ety and depression had good effect,and the adverse reactions were mild and safe.

Effect of esophageal mucosal acid exposure on visceral sensation of patients with non-erosive gastroesophageal reflux disease / 第三军医大学学报

Objective To investigate the effect of esophageal mucosal acid exposure on visceral sensation of patients with non-erosive gastroesophageal reflux disease (NERD) and to evaluate the role of visceral hypersensitivity in NERD pathogenesis. Methods We recruited 21 NERD patients and 10 normal healthy volunteers. Mechanical distentions stimulation and acid perfusion through esophagus were performed using the balloon-affixed and polyvinyl multilumen catheter. Esophageal visceral perception thresholds were examined before and after acid perfusion with esophageal balloon distention by means of a computer-controlled barostat. Results As compared with healthy subjects, NERD patients demonstrated significantly lower initial perception threshold and maximally tolerated pain threshold (P

Study on the pathogenesis of non-erosive gastroesophageal reflux disease / 中国实用内科杂志

Objective To study the different pathogenesis between non-erosive gastroesophageal reflux disease(NERD) and reflux esophagitis(RE).Methods 57 patients with regurgitation or heartburn from 1996 to 2004 were assessed in this study.Patients with esophageal mucosal break by endoscopy were regarded as the RE group,others as the NERD group.The clinical feature and whether complicating with H.pylori infection in both groups were reviewed and all patients underwent esophageal manometry and 24 hours esophageal/gastric pH monitoring.Results No differences of age?sex?smoking?drinking and Hp infection were found between the two groups.The incidence of the atypical reflux symptom (chest pain) in the NERD group was higher than in the RE group.There was pathologic acid reflux in both groups,but the two groups did not differ at reflux degree.Esophageal body peristaltic amplitude of the NERD group was higher than that of the RE group.Average gastric pH of the NERD group in supine was lower compared with the RE group.Conclusion In the NERD patients,the incidence of the atypical reflux symptom is more prevalent.It is the esophageal acid clearance not the reflux degree that plays an important role in the different pathogenesis between NERD and RE.

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.