| Objective:Using case-control study to compare the clinical characteristies of age,sex, body mass index(BMI),esophageal acid and bile exposure in patients with reflux esophagitis(RE),non-erosive reflux disease(NERD) and Barrett's esophagus(BE). Then proceeds to study the esophageal motor function and Helicobacter pylori(Hp) infection in some patients .Methods:Patients complaining of reflux symptoms or extra-esophageal manifestations except the other diseases were studied with upper gastrointestinal endoscopy and graded to RE,NERD,and BE,52 patients with RE,59 patients with NERD,23 patients with BE. A piece of endoscopic biopsy specime from gastric antrum was got to biopsy urease test. Simultaneous ambulatory 24-h esophageal pH and bilirubin monitoring (Bilitec 2000) were done to all patients.All of them were recruited by age,sex,weight and height.Results: (1)The patients with GERD,52 (38.81%) had RE,59(44.03%) had NERD, 23 (17.16%) had BE.The ratio of sex (male:female) were 1.1:1,1.3:1,4.8:1 and the mean age were 44.4±11.0,51.0±12.8,51.5±12.1 respectively in RE,NERD and BE groups.There were more males than females in BE group. The mean age of RE was younger than NERD and BE groups.BMI of them were 22.16±3.25 kg/m2,22.70±5.18 kg/m2 and 24.28±3.80 kg/m2 respectively.The difference in BMI was no significance among them,however the proportion of hypergravitation(60.9%) was much higher. (2) The parameter of esophageal motor function just like lower esophageal sphincter(LES) pressure ,the length of LES, the length of upper esophageal sphincter ,distal esophageal motility duration in RE,NERD and BE groups were lower than normal mean value. There was high incidence of ineffective esophageal motility in GERD patients. (3)The fraction of times pH < 4 for total, and upright periods, number of acid refluxes,longest acid reflux duration, DeMeester score in RE,BE groups were higher than NERD group. The fraction of times abs≥0. 14 for supine in BE was lower than RE. (4)The ratio of pathological reflux were 65.39%,52.54%,82.61%respectively in RE,NERD and BE groups, and 21.15 %,13.56%,30.43% had mixed acid and bile reflux respectively.The rate of pathological reflux,especially mixed acid and bile reflux was higher in BE group. (5)The ratio of midrange and severity acid reflux in RE and BE groups were higher than NERD group.There was more patients with no acid reflux(57.63%)in NERD group. (6) The acid exposure level of mixed acid and bile reflux was higher than pathological acid reflux only.(7)The patients with NERD, 56.8% had abnormal acid or bile reflux,43.2% had no reflux,and 8.1% was symptom index (SI) +,35.1% was SI-in no reflux. (8)The level of acid exposure in SI+ higher than SI-. (9)The positive rate of Hp infection were 25%,22.2%,27.3% respectively in RE,NERD and BE groups, no significance differences were found among them.Conclusions:(1)The subtypes of GERD was mainly with NERD,and was relatively a less with BE.The patients with RE were younger,while most patients with BE occurred in middle and old age, overweight males. (2)The esophageal motor function were abnormal in RE,NERD and BE groups. (3)The degree of acid reflux was more seriously in RE and BE groups than NERD group,and had more mixed acid and bile reflux.It may be taken as the determinator in the differences of endoscopic features. (4)The subtypes of NERD can be divided into pathological reflux, esophageal acid sensitive.Some patients with SI-maybe diagnosed as functional heartburn.The level of acid exposure in esophageal acid sensitive was higher than in SI-. (5)Hp infection can not be taken as the determinator in the differences among RE,NERD and BE groups.
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