Objective To analyze the differences in symptoms spectrum,lifestyle,diet and psychological features among different age groups with reflux esophagitis.Methods From June 2011 to October 2013,332 outpatients with reflux esophagitis (RE) were collected and divided into youth group (18 to 40 years),middle-aged group (41 to 64 years) and aged group (≥65 years).Symptoms and risk factors of patients were investigated.The severity of the symptoms was evaluated with reflux diagnostic questionnaire (RDQ).The anxiety and depression of patients were assessed with self-rating anxiety scale (SAS) and self-rating depression scale (SDS).The distribution of symptoms spectrum,the severity of symptoms,lifestyle,diet and psychological features of three groups were compared.Mann-Whitney U tests or Chi-square test were used for comparison between two groups.Pearson test was performed for correlation analysis.Results There were 96 cases,192 cases and 44 cases in youth,middle-aged and aged group,respectively.Compared with youth group and middle-aged group,the incidence of chronic cough and asthma (extra-esophageal symptoms) was higher in aged group (1.0％ (1/96),13.5％ (26/192),20.5 ％ (9/44);and 3.1％ (3/96),9.4 ％ (18/192),15.9 ％ (7/44)),and the differences were statistically significant (x2 =15.10 and 6.91,both P＜0.05).The scores of extra-esophageal symptoms in youth group,middle-aged group and aged group were 7.0(2.0,14.0),9.5(4.2,17.0) and 12.0(7.0,19.7),respectively,and the difference was statistically significant (F=3.93,P =0.02).Comparison with aged group,the incidences of youth group and middle-aged group were higher in irregular meals (4.5 ％ (2/44),28.1％(27/96),14.6％ (28/192)),overeating (29.5％(13/44),50.0％(48/96),34.9％(67/192)),dinner time after 19 o'clock (2.2％(1/44),27.1％(26/96),20.3％(39/192)),lying down in 30-minute post-meal (40.9％(18/44),63.5％(61/96),49.5％(95/192)),high fat diet (52.3％(23/44),84.4％ (81/96),69.3％(133/192)),spicy food (13.6％(6/44),43.8％(42/96),30.7％(59/192)),and the differences were statistically significant (x2 =13.93,7.90,11.71,10.36,16.22 and 12.99,all P＜ 0.05).Compared with the youth group and middle-aged group,the incidence of aged group was higher in exercise times ＜two times/week (15.6 ％ (15/96),40.1％ (77/192),50.0％ (22/44)),preference of tea (36.5％(35/96),36.5％(70/192),59.1％ (26/44)) and poor sleep quality (13.5％ (13/96),19.3％ (37/192),31.8％(14/44)),and the differences were statistically significant (x2 =22.52,8.18 and 6.47,all P＜ 0.05).The median SAS scores of youth group,middle-aged group and aged group were 30.0 (27.5,33.7),32.5 (28.7,37.5) and 30.0(27.5,36.2),respectively;and the median SDS scores were 32.5(27.5,39.7),36.2(30.3,45.0),37.5(35.0,45.0),respectively;and the differences in SAS and SDS scores among three groups were statistically significant (F=6.37,6.75,both P＜0.01).The SAS and SDS scores were not correlated with extra-esophageal symptoms in youth group.The SAS score was positively correlated with extra-esophageal symptoms in middle-aged group (r =0.19,P =0.009).The SAS and RDQ scores were positively correlated with extra-esophageal symptoms in aged group(r=0.26 and 0.23;P=0.005 and 0.003).Conclusions The incidence of extra-esophageal symptoms in middle-age group and aged group is high,the symptoms are severe and with anxiety and depression possibility.While unhealthy lifestyle and diet habits are more common in young patients.According to different age groups,risk factors should be adjusted.

Objective:To evaluate the role of esophagogastric junction contractile index (EGJ-CI) in distinguishing patients with refractory gastroesophageal reflux disease (RGERD) from functional heartburn (FH).Methods:From March 2014 to January 2018, 82 patients with proton pump inhibitor (PPI) refractory heartburn and/or regurgitation, who visited the Outpatient Department of Gastroenterology at The First Affiliated Hospital with Nanjing Medical University were enrolled, among them 50 patients with RGERD (RGERD group) and 32 patients with FH (FH group). EGJ-CI of RGERD group and FH group were compared. The sensitivity and specificity of EGJ-CI to distinguish RGERD from FH patients. The correlation between EGJ-CI and high resolution esophageal manometry parameters, baseline impedance level and 24 h impedance-pH monitoring parameters were analyzed. Mann-Whitney U test, receiver operator characteristic curve analysis and Spearman correlation analysis were used for statistical analysis. Results:The EGJ-CI of RGERD group was lower than that of FH group (25.8 mmHg·cm (14.1 mmHg·cm, 35.9 mmHg·cm)(1 mmHg=0.133 kPa) vs. 39.2 mmHg·cm (23.0 mmHg·cm, 60.8 mmHg·cm)), and the difference was statistically significant ( Z=-2.833, P=0.005). When the cut-off value of EGJ-CI was 35.8 mmHg·cm, the sensitivity and specificity to distinguish RGERD from FH were 76.0% and 62.5%, respectively; area under the curve was 0.69 (95% CI 0.57 to 0.81). EGJ-CI was positively correlated with lower sphincter resting pressure, integrated relaxation pressure, distal contractile integral, distal esophageal pressure, and mean nocturnal baseline impedance ( r=0.812, 0.631, 0.451, 0.490 and 0.401, all P<0.01). EGJ-CI was negatively correlated with DeMeester score, acid exposure time, total reflux episodes, acid reflux episodes, long reflux episodes and longest reflux time ( r=-0.363, -0.372, -0.346, -0.318, -0.300 and -0.291, all P<0.01). Conclusions:EGJ-CI can help to distinguish patients with FH from RGERD.

Objective:To analyze the clinical characteristics of functional esophagogastric junction outflow obstruction (EGJOO) and to improve the knowledge of functional EGJOO.Methods:From January 2015 to December 2019, at the Gastrointestinal Motility Center of The First Affiliated Hospital with Nanjing Medical University, 91 patients who underwent high resolution esophageal manometry (HREM) and met the EGJOO criteria of Chicago Classification for esophageal motility disorders, 3rd edition and excluded organic diseases by examination such as gastroscopy or upper gastrointestinal radiography were collected. The clinical manifestations, treatment methods, effect and clinical outcome of patients with functional EGJOO, the HREM parameters of patients with different clinical manifestations as well as symptoms and HREM parameters of patients with different treatments were analyzed. Least significant difference test or Tamhanes T2 test, Mann-Whitney U or Wilcoxon test, chi-square test or Fisher exact test were used for statistical analysis. Results:The most common symptom of 91 functional EGJOO patients was dysphagia (34/91, 37.4%). The lower esophageal sphincter pressure (LESP) and the intrabolus pressure during relaxation of the lower esophageal sphincter (IBP LESR) of patients with dysphagia were both higher than those of patients without dysphagia (30.95 mmHg (26.27 mmHg, 39.37 mmHg) (1 mmHg=0.133 kPa) vs. 27.35 mmHg (24.60 mmHg, 34.87 mmHg); (8.25±4.64) mmHg vs. (5.69±4.65) mmHg), and the differences were statistically significant ( Z=2.076, t=2.539; P=0.038, 0.013). Thirty patients (33.0%) had no special treatment, 52 patients (57.1%) were treated with medication, and nine patients (10.0%) underwent peroral endoscopic myotomy (POEM). The incidence of dysphagia before treatment and maximum intrabolus pressure of patients who underwent POEM were both higher than those of patients without special treatment and medication treatment (8/9 vs 43.3%, 13/30 and 25.0%, 13/52; 21.80 mmHg (15.45 mmHg, 28.95 mmHg) vs. 12.20 mmHg (10.00 mmHg, 18.10 mmHg) and 13.70 mmHg (11.07 mmHg, 17.82 mmHg)), and the differences were statistically significant (Fisher exact test, Fisher exact test; Z=2.814, 2.390; P=0.023, P<0.01, P=0.005, 0.017). The incidences of delayed esophageal emptying or esophageal dilation of patients who underwent POEM, without special treatment and with medication treatment was 6/9, 5/14 and 3/18, respectively, and the differences were statistically significant among three groups (Fisher exact test, P=0.039). Among them, the incidence of delayed esophageal emptying or esophageal dilation of patients received POEM before treatment was higher than that of patients with medication treatment (Fisher exact test, P=0.026). The symptoms of 24.2% (22/91) was spontaneously relieved, and two patients (2.2%) developed type Ⅱ achalasia during follow-up. Conclusions:The main manifestation of patients with functional EGJOO is dysphagia. Patients with significantly increased LESP and IBP LESP are more likely to have dysphagia. Patients with obvious signs of esophageal gastric junction obstruction are more inclined to choose POEM treatment. Some patients with functional EGJOO can relieve themselves, and a few patients can develop achalasia.

Objective To investigate the correlation between the clinical symptoms of patients with achalasia of cardia (AC) and high-resolution manometry (HRM) parameters.Methods The clinical data of 30 AC patients were retrospectively analyzed.The severe degree of symptoms was evaluated by Eckardt score questionnaires,and motility of esophagus was assessed by HRM parameters.According to Chicago classification,patients were divided into three types.Mann-Whitney U test was performed for non normal distribution quantitative data comparison.Spearman correlation was used to analyze the correlation between AC symptoms and the HRM parameters.Results The reflux symptom of type Ⅱ patients was more severe than that of type Ⅰ patients (2.50(1.00) vs 1.00(1.50),U=56.000,P＜0.05).The integrated relaxation pressure (IRP) was moderately correlated with total Eckardt score of all AC patients,the frequency of reflux and the degree of body weight loss (r=0.528,0.441 and 0.662,all P＜0.05),furthermore IRP was strongly correlated with the degree in weight loss in type Ⅰ AC patients (r =0.703,P＜ 0.05).Lower esophageal sphincter resting pressure was weakly correlated with the degree of weight loss in all AC patients (r=0.398,P＜0.05).Conclusions The degree of severity of symptoms may be different in different types of AC patients.HRM parameters,especially IRP,might play a role in the assessment of severity of AC symptoms.

Objective To analyze clinical characteristics of gastroesophageal reflux disease(GERD) in aged patients for improvement of diagnosis and treatemcnt. Methods The reflux disease questionnaire was performed in patients diagnosed as GERD based on Montreal definition and classification as well as Rome Ⅲ criteria.All patients were divided into elderly group (≥65 years) and control group(＜65 years). The incidence of hita[ hernia (HH), the frequencies of esophagitis (based on Los Angeles classification), clinical features, and quality of life were compared between two groups. Results There was no difference between two groups in male/female ratio and morbidity of HH(P＞0.05). In comparison with control group, the frequency of esophagitis graded as LC or LD increased and extra-esophageal symptoms were higher in elderly group (P＜ 0.05), but the lower typical symptoms (heartburn and regurgitation) were seen in the elderly group(P＜0.05). The scores of role physical, bodily pain and role emotional were higher in elderly group than those in control group (P＜0.05). There was no significant differences between two groups in physical function, vitality,social functioning, mental health, and general health. Conclusion The elderly GERD patients often have lower score of typical reflux symptoms (heartburn and regurgitation) and high incidence of severer esophagitis, but their quality of life is not significantly influenced.

The Rome IIII( criteria were released in May 2016. Based on the development of brain-intestinal axis theory, intestinal microecology, pharmacogenomics and social psychology, the Rome IIII( criteria revise the definition, diagnostic criteria, clinical evaluation process, and treatments of functional constipation (FC). The revisions are as follows: (1) Definition: FC and constipation-predominant irritable bowel syndrome are considered to be on a continuum rather than as independent entities. (2) Diagnostic criteria: the Bristol stool scale type 1, type 2 and spontaneous bowel movements are added in the diagnostic criteria, respectively, refining the criteria for stool consistency and frequency. (3) Clinical evaluation process: the Rome IIII( criteria specifies the clinical assessment procedure for FC. The aim is to exclude organic disease, to detect the structural changes of the combination, to determine the type of guidance therapy, and to reduce unnecessary checks to improve diagnostic efficiency. (4) Pathophysiologic mechanism: much more newly investigated mechanisms are added, including the risk factors, genetics, inadequate colonic propulsion and defecation disorder. (5) Treatment: the treatment regimen summarizes the evidence-based medical evidence of new drugs, such as secretagogues and bile acid transport inhibitors, and evaluates the safety of all the new and old drugs. Compared to the Rome III( standard, the diagnosis of FC will be more stringent and efficient, and the treatment options will be more standardized and reasonable with the Rome IIII(.

At present，many studies showed that food intolerance (FI) is one of the important factors for the occurrence and aggravation of irritable bowel syndrome (IBS). The FI in IBS patients is related to low grade inflammation of intestine. Fermentable oligo‑，di‑，monosaccharides and polyols (FODMAPs) diet can improve the symptoms of IBS and provide a new idea for exploring the pathogenesis and treatment of IBS. This article reviewed the advances in study on role of FI in pathogenesis of IBS.

Background/Aims: The efficacy and safety of anti-reflux mucosectomy (ARMS) or radiofrequency energy delivery in the treatment of gastroesophageal reflux disease (GERD) have been reported, but the difference between the 2 remains unclear. Methods: This was a single center, randomized, comparative clinical study. Patients with symptoms of heartburn and/or regurgitation despite proton pump inhibitor treatment were randomly assigned to either ARMS group (n = 20) or radiofrequency group (n = 20).Primary outcome was the standardized GERD questionnaire (GERDQ) at 2 years after the procedures. Secondary outcomes were the proportions of patients with complete proton pump inhibitor (PPI) cessation and patients satisfied with the treatment. Results: A total of 18 patients randomized to ARMS and 16 to radiofrequency were analyzed in this study. The operation success rate of the 2 groups was 100%. In both ARMS and radiofrequency groups, GERDQ scores at 2 years after the procedures were significantly lower than that before operation (P = 0.044 and P = 0.046). At 2 years postoperatively, the scores of GERDQ did not differ between the 2 groups (P = 0.755). There was no significant difference in the rate of discontinuation of PPIs and patient satisfaction in the ARMS and radiofrequency groups (P = 0.642 and P = 0.934). Conclusions The clinical efficacy of ARMS and radiofrequency for the PPI-refractory GERD is equivalent. ARMS, the efficacy of which could be maintained for at least 2 years, is promising endoscopic management for the treatment of refractory GERD.

BACKGROUND/AIMS: Little data exists about esophageal body dysmotility and reflux patterns in refractory gastroesophageal reflux disease (RGERD) patients off therapy. We aimed to evaluate effects of esophageal body dysmotility on reflux parameters in RGERD patients by combining impedance-pH monitoring and high-resolution manometry (HRM). METHODS: We retrospectively reviewed the impedance-pH data and HRM metrics in patients with refractory gastroesophageal reflux symptoms. Impedance-pH monitoring and manometric data were compared between 2 groups: ineffective esophageal motility (IEM) and normal motility. RESULTS: Forty-eight patients (30 males, mean age 54.5 years) were included (16 erosive esophagitis, 24 non-erosive reflux disease, and 8 functional heartburn), amongst which 24 subjects showed IEM, and others had normal motility. Number of patients who had a large break in the IEM group was significantly higher than that of normal motility patients. IEM group had more patients with weakly acid reflux and long term acid reflux than the normal group (P = 0.008, P = 0.004, respectively). There was no statistical difference in baseine impedance levels from z4 to z6 between the 2 groups (2911 ± 1160 Ω vs 3604 ± 1232 Ω, 2766 ± 1254 Ω vs 3752 ± 1439 Ω, 2349 ± 1131 Ω vs 3038 ± 1254 Ω, all P > 0.05). Acid exposure time, numbers of long term acid reflux and weakly acid reflux showed strong negative correlation with esophageal body motility and/or lower esophageal sphincter function. CONCLUSIONS: IEM was associated more with acid exposure, abnormal weakly acid reflux, and long term acid reflux in RGERD patients. These data suggested the role of esophageal body dysmotility in the pathophysiological mechanisms of RGERD patients.
Electric Impedance ; Esophageal Motility Disorders ; Esophageal Sphincter, Lower ; Esophagitis ; Gastroesophageal Reflux* ; Humans ; Male ; Manometry ; Retrospective Studies