Comparison of esophageal motility and reflux characteristics of patients with endoscopic-negative heartburn based on the Lyon Consensus
- VernacularTitle:基于里昂共识诊断的内镜阴性烧心患者的食管动力及反流特征比较
- Author:
Siyu LIAO
1
;
Mimi LIU
1
;
Jing ZHOU
1
;
Jiamin HAO
1
;
Yizun CHENG
1
;
Yanpin WU
1
;
Xuefen GAO
1
;
Yan CHENG
1
Author Information
- Publication Type:Journal Article
- Keywords: non-erosive reflux disease; reflux hypersensitivity; functional heartburn; esophageal high-resolution manometry; 24 h-pH impedance monitoring
- From: Journal of Xi'an Jiaotong University(Medical Sciences) 2022;43(4):545-549
- CountryChina
- Language:Chinese
- Abstract: 【Objective】 To explore the characteristics of esophageal motility and reflux of endoscopic-negative heartburn patients based on the Lyon Consensus Diagnostic Criteria and discuss the differential diagnosis value of the mean nocturnal baseline impedance （MNBI） and the postreflux swallow-induced peristaltic wave （PSPW） index for reflux hypersensitivity （RH） and functional heartburn （FH） patients. 【Methods】 We enrolled 132 patients with heartburn as the main symptom who visited the Gastroenterology Department of our hospital from January 2017 to June 2021， including 24 in the non-erosive reflux disease （NERD） group， 24 in the RH group， and 84 in the FH group. All the patients completed gastroscopy， esophageal high-resolution manometry and 24h-pH impedance monitoring. We analyzed and compared the related indexes of esophageal motility and reflux. The receiver operating characteristic （ROC） curve was used to analyze the esophageal proximal MNBI， distal MNBI， and PSPW indexes for the differential diagnosis of RH and FH. 【Results】 The lower esophageal sphincter （LES） average resting pressure， LES residual pressure and intact relaxation pressure （IRP） in NERD were lower than those in RH and FH （P<0.05）. The number of acid reflux， the upright acid exposure time （AET）， the supine position AET， the total AET， and the DeMeester score were higher in NERD than in RH and FH （P<0.05）. The non-acid reflux， distal MNBI and PSPW indexes were lower in NERD than in RH and FH （P<0.05）. The distal MNBI and PSPW indexes were lower in RH than in FH （P<0.05）. However， there was no significant difference in proximal MNBI among the three groups （P>0.05）. When the proximal MNBI， distal MNBI， and PSPW indexes were used alone respectively to diagnose RH， the area under the ROC curve was 0.480， 0.810， 0.682， respectively， with the sensitivities being 87.5%， 100% and 91.7%， and the specificities being 26.2%， 66.7% and 51.2%， respectively. 【Conclusion】 NERD patients have obvious abnormal esophageal dynamics， mainly manifested as LES relaxation， which further aggravates the pathological acid reflux， while patients with RH and FH are mainly exposed to physiological acid or non-acid reflux. In patients with endoscopic negative heartburn， distal MNBI value can improve the clinical diagnosis rate of RH and help distinguish RH from FH.
