Comparison of esophageal motility between gastroesophageal reflux disease and functional esophageal disorders based on Lyon consensus

Abstract

Objective To analyze the differences in esophageal motility between patients with gastroesophageal reflux disease (GERD) and functional esophageal disorders by comparing the esophagogastric junction (EGJ) barrier function, esophageal body motor function and results of provocative test. Methods From December 2016 to December 2018, the 100 patients with typical symptoms of GERD, who visited The First Aftiliated Hospifal of Zhejiang Chinese Medical Universtiy wese selected. According to the Rome Ⅳ standand and the Lyon consensus, and the results of endoscopic examination, 24 h multichannel intratuminal impedante pH (MII-pH) monitoring and esophageal high resolution manometry (HRM), the patients were divided into GERD group (n=32), hypersensitivity(RH) group (n=33) and functional heartburn(FH) group (n=35). According to the results of esophageal HRM, the differences in esophageal dynamics among the groups were analyzed. T test, variance analysis and Chi square test were performed for statistical analysis. Results The lower esophageal sphincter (LES) resting pressure of GERD group was lower than that of FH group ((19.37±7.92) mmHg vs. (25.35±12.38) mmHg (1 mmHg=0.133 kPa)); the EGJ-contractile integral of GERD group and RH group was lower than that of FH group ((20.84±21.52) mmHg·cm and (20.72±19.35) mmHg·cm vs. (35.93±36.82) mmHg·cm), and the level of distal contractile integral of GERD group was lower than that of FH group and RH group ((802.35±496.86) mmHg·s·cm vs. (1 316.84±853.92) mmHg·s·cm and (1 141.65±607.93) mmHg·s·cm), and the differences were statistically significant (t=-2.377, -2.069, -2.149, -3.045 and -2.467, all P<0.05). There were no major motility disorders in patients of the three groups. The incidence of ineffective oesophageal motility of GERD group was higher than that of RH group and FH group (62.5%(20/32) vs. 39.4%(13/33) and 25.7%(9/35)), and the differences were statistically significant (χ2=4.440 and 9.214, both P<0.05). Conclusions GERD patients have abnormal esophageal motility, which is mainly manifested by reduced LES resting pressure, decreased EGJ barrier function, and abnormal peristalsis of the esophagus. Patients with RH also have decreased EGJ barrier function. Key words: Gastroesophageal reflux; Functional heartburn; Reflux hypersensitivity; High resolution manometry; Lyon consensus