Reflux Pattern Detected By Multichannel Intraluminal Impedance-pH Technique In The Groups Of Different Manifestations About Refractory Gerd Patients

Background:Proton pump inhibitors arewidely used in thetreatment of gastroesophageal reflux disease,but some GERD patients have poor response to PPIs, whether associated with the reflux pattern.Objective:Application 24-hour multichannel intraluminal impedance-p H technique to study the reflux pattern of carious refractory GERD patients.Methods:The patients meet the standards to diagnosis refractory GERD,from September 2012 to February 2015,24-hour impedance-p H monitoring wasperformed,when De Meester≥14.72,those with heartburn,regtlrgitation symptom were defined as typical symptom group,those with noncardiac chest pain,swallowing discomfort and dyspepsia etc were defined as atypical symptoms group,with chronic cough, asthma, sore throat, etc defined as extraesophageal symptoms group. The parameters of MII-p H were compared among the groups.Results:Finally 59 patients were defined as GERD, typical symptom group was 21 people, atypical symptoms group was 18 people, extraesophageal symptoms group was 20 people.Gender,age,BMI were undifferentiated among the groups.The percentage of total reflux time in subgroup of GERD were no difference(P>0.05). The frequencies of proximal reflux in the groups were 37(15,52) vs 14(8, 38) vs 28(19, 42),respectively. Proximal reflux in refractory GERD groups were based of acid reflux, 64.84%,64.44%,61.41%, respectively. In GERD subgroups,the numbers of weakly acidic reflux in atypical symptoms group was higher than the extraesophageal symptoms group(P<0.05). The mainly distal reflux about refractory GERD were weakly acid reflux(53.88%, 50.00%, 62.26%, respectively). 80% the number of reflux was distal reflux.Among the GERD subgroups, the atypical symptoms group was higher than the extraesophageal symptoms group about the weakly acid reflux number(P < 0.05). Weakly acid reflux was priority in the groups, the secondary was acid reflux. The atypical symptoms group of mixed reflux numbers was higher than the extraesophageal symptoms group(P < 0.05), no significant difference among the other groups. Mixedreflux was priority in the groups, liquid reflux was secondary. Bolus clearance time has nothing to do with the position.Upright position, the atypical symptoms group and extraesophageal symptoms group about weakly acid reflux number had difference(P < 0.05), and the others were no statistical difference.Conclusion: Weakly acidic and mixed reflux was predominant in refractory GERD patients. Acid reflux was priority to proximal reflux in refractory GERD groups,the control group is weakly acid reflux. The atypical symptoms group of weakly acidic reflux numbers was higher than the extraesophageal symptoms group.