Correlation Analysis Between Esophageal Acid Exposure And Esophageal Motility Disorder In GERD Patients

Objective: In this study,esophageal kinetic parameters in GERD patients with different acid exposure conditions were analyzed in order to reveal the esophageal dyskinesia pattern in GERD patients with different acid reflux degrees.Method: A total of 64 healthy subjects and GERD patients who underwent24 hp H monitoring in the First Affiliated Hospital of Hebei North University were collected by current situation investigation method.Clinical data of the patients including age,gender,BMI,hospital anxiety and depression scale HADS and gastroscopy were recorded and sorted out.According to the 24 hp H monitoring results,the patients were divided into:There were 10 cases in the blank control group(Demeester score<14.72) and 54 cases in the GERD group(Demeester score≥14.72).The latter group was further divided into: There were 18 cases in the mild acid exposure group(14.72≤Demeester score<50),18 cases in the moderate acid exposure group(50≤Demeester score<100)and 18 cases in the severe acid exposure group(Demeester score≥100).The results of nine esophageal dynamic parameters,including LESP,UESP,DEP,DCI,IEM,weak contraction,failed contraction,small peristaltic interruption proportion and large peristaltic interruption proportion,were obtained by solid-state high resolution esophageal manometry,and were statistically analyzed.Results:(1)24hph monitoring results: The total acid exposure time and Demeester score of blank control group,mild acid exposure group,moderate acid exposure group and severe acid exposure group increased successively,with statistical significance between groups(P<0.05),and pairwise comparison between groups showed statistically significant differences(P<0.05).(2)Solid high resolution esophageal manometry results: LESP,DEP and DCI of blank control group,mild acid exposure group,moderate acid exposure group and severe acid exposure group decreased successively,with statistical significance(P<0.05),while UESP results increased successively,with no statistical significance(P>0.05).The results of IEM,the proportion of failed contraction and the proportion of large peristaltic interruption increased successively among the four groups,with statistical significance(P<0.05).There were statistically significant differences in LESP,DEP and DCI between blank control group and GERD group(P<0.05),and there were statistically significant differences in IEM,proportion of weak contraction,proportion of failed contraction,proportion of small peristaltic interruption and proportion of large peristaltic interruption(P<0.05).Pairwise comparison of GERD groups showed statistically significant differences in LESP,DEP and DCI results(P<0.05),but no statistically significant differences in the proportion of interruption of small peristaltic contraction(P>0.05).There were statistically significant differences in the proportion of failed shrinkage and the proportion of large peristaltic interruption(P<0.05).There were no statistically significant differences in IEM between moderate and severe acid exposure groups(P>0.05),and there were no statistically significant differences in the proportion of weak shrinkage between mild and moderate acid exposure groups(P>0.05).(3)Correlation and regression: Demeester score had significant linear correlation with LESP(r =-0.757),DEP(r =-0.791),IEM(r = 0.709)and DCI(r =-0.641)results,respectively(P<0.05).After controlling for two(potential)confounding factors of hospital anxiety and depression scale(with or without anxiety and/or depression)and gastroscopy(with or without reflux esophagitis),Demeester score still had statistically significant effects on LESP,DEP,IEM and DCI(P<0.05).Conclusions: 1.Increased exposure to esophageal acid is associated with increased esophageal motility disorders.2 Lower esophageal sphincter pressure,distal esophageal pressure and distal systolic score decreased with the increase of acid exposure,while ineffective esophageal motion increased with the increase of acid exposure.3 Ineffective esophageal exercise was more common in GERD patients than in normal population,and was more obvious in moderate and severe acid reflux patients.4 The pattern of weak esophageal contraction was obvious in mild and moderate acid reflux groups,and the failure of small peristalsis was manifested in different acid exposure groups.Failure peristalsis and large peristalsis interruption were more obvious with higher acid exposure.5 There is insufficient evidence as to whether esophageal motility disorders are the primary cause or a secondary abnormality in the development of GERD.