Clinical Study Of PECC For The Treatment Of Refractory Gastroesophageal Reflux Disease With Atypical Symptoms

Objective: Currently,medication is still the main treatment for gastroesophageal reflux disease(GERD),but patients with refractory gastroesophageal reflux disease(RGERD)who still Invalid or ineffective after 8 weeks of treatment with double dose acid suppressant drugs may need to seek other treatment options.RGERD often presents atypical symptoms,which may be related to cardiac relaxation based on the results of esophageal acid pressure measurement and gastroscopy.In this study,we conducted peroral endoscopic cardiac constriction(PECC)treatment for patients with atypical symptoms of RGERD with low degree of cardiac relaxation,to evaluate the efficacy and safety of PECC in the treatment of patients with atypical symptoms of RGERD,and to provide reference for the treatment of patients with RGERD.Methods: The data of 29 patients with atypical symptoms of RGERD who underwent PECC in our hospital from December 2021 to December 2022 were collected.By comparing preoperative and postoperative symptom relief,use of acid suppressants,GERD health-related quality of life(GERD-HRQL)scores,GERD questionnaire(GERD-Q)scores,reflux symptom index(RSI)scores,and other related symptom scores,postoperative complications were recorded to analyze the therapeutic efficacy and safety of PECC for patients with atypical symptoms of RGERD.Results: After PECC treatment,atypical symptoms such as chest and back pain,throat discomfort,bitter mouth,cough,belching,palpitations,and chest tightness were significantly alleviated,with a total effective rate of 96.6% and patient satisfaction of 100%.Compared with pre treatment,most patients stopped or reduced the use of acid suppressants after PECC treatment,with a drug removal rate of 93.1%.The postoperative follow-up period was 3-15 months(an average of 6 months).The results of postoperative follow-up showed that the symptom scores of GERD-HRQL [preoperative(17.38 ± 8.61)score vs postoperative(5.28 ± 3.84)score,t=9.75,P<0.01],GERD-Q [preoperative(9.41 ± 2.71)score vs postoperative(6.48 ± 1.30)score,t=6.19,P<0.01],and RSI [preoperative(10.38 ± 3.25)score vs postoperative(2.72 ± 1.67)score,t=14.96,P<0.01] were significantly lower than those before treatment.There were no serious complications after PECC treatment.Poststernal pain,choking sensation,palpitations,chest tightness,nausea and vomiting and other discomfort symptoms after PECC treatment can be improved in a short period of time.Conclusions: 1.PECC has a significant short-term effect on RGERD patients with atypical symptoms,and can be used as a supplement to GERD treatment.2.Cardiac relaxation may be the main cause of RGERD.