The Correlationship Between Heterotopic Gastric Mucosa In The Upper Esophagus And Gastroesophageal Reflux Disease

Objective: To investigate the relationship between upper esophageal mucosa heterotopia(HGMUE)and acid reflux disease(GERD),and the possible role of esophageal motility in esophageal reflux.Methods: From May 2020 to November 2021,ninety patients diagnosed with HGMUE in the Digestive Disease Center of Suining Central Hospital were enrolled into the HGMUE group.Thirty healthy volunteers without any symptoms or digestive diseases from the physical examination center of Suining Central Hospital in the same period were enrolled into the healthy control group.The demographic characteristics of all enrolled study subjects were collected and analyzed.All study subjects were required to have esophagogastroduodenoscopy(EGD),high resolution esophageal manometry(HRM)and24-hour pH combined impedance monitoring(24h MII-pH).Patients with HGMUE were divided into HGMUE with GERD group(HGMUE-G)and HGMUE without GERD group(HGMUE-NG)based on the result of 24 h MII-pH.The endoscopic and pathological characteristics of HGMUE and the morbidity of GERD in patients with were analyzed,and the esophageal motility and the reflux characteristics of subjects between HGMUE group and healthy control group and between HGMUE-G group and HGMUE-NG group were compared.Results: Among these 90 patients with HGMUE,there were 26 patients(28.89%)were endoscopically positive GERD.Totally,there were 59 patients(65.56%)diagnosed with GERD based on the continual and dynamic reflux monitoring using 24 h MII-pH.Regarding the comparison between the HGMUE group and the healthy control group,there were 90 patients with HGMUE enrolled into the HGMUE group and 30 healthy volunteers enrolled into the healthy control group.No significant statistical difference were found as for the demographic characteristics between the two groups.However,the esophageal motility parameters including the proportions of ineffective esophageal motility(IEM),distal contractile integral(DCI)and pressure of the lower esophageal sphincter(LES)were significantly worse in the HGMUE group compared to the healthy control group(P<0.01).Correspondingly,the reflux related parameters including the percentage of the acid exposure time(AET%)(6.05% vs.1.00%,P<0.01)and the total reflux episodes(64 vs.47,P<0.01)were significantly higher in the HGMUE group compared to the healthy control group.Specifically,compared to the healthy group,the total proximal acid(35 vs.12,P<0.01)and weakly acid(15 vs.10,P=0.01)reflux episodes in the HGMUE group were significantly higher.Regarding the comparison between the HGMUE-G group and HGMUE-NG group,there were 59 patients(65.56%)enrolled into the HGMUE-G group and 31 patients(34.44%)enrolled in the HGMUE-NG group.Comparing the two groups,more male and higher body mass index(BMI)were found in HGMUE-G group(P<0.01).The reflux related parameters including AET%(8.20% vs.3.00%,P<0.01),the total reflux episodes(70 vs.57,P=0.02)and the total proximal acid reflux episodes(40vs.16,P<0.01)were significantly higher in the HGMUE-G group compared to the HGMUE-NG group.Conclusion: HGMUE is often associated with GERD,and HGMUE esophageal dyskinesia may be one of the causes of GERD,especially proximal acid reflux.