Diagnostic value of intraductal ultrasonography for biliary stricture

Abstract

Objective To explore the pathogenesis of reflux esophagitis （RE） and non-erosive reflux disease（ NERD）, and their scientific basis in clinical treatment by comparing the clinical characteristics of esophageal acid exposure,lower esophageal sphincter pressure （LESP） , esophageal pressure, and Helicobacter pylori infection in RE and NERD. Methods In this study, there were 80 cases with typical symptoms （heartburn and acid regurgitation）, of which 31 cases were diagnosed as RE ,45 cases as NERD and 4 cases as Barrett＇s esophagus by gastroscopy. In gastroesophageal reflux disease （GERD） the extents of esophageal acid exposure, based on the result of ambulatory 24h esophageal pH monitoring and the mean De-Meester points, were allocated into three levels, slight, medium and severe. Monitoring LESP, esophageal body contraction amplitude,namely LS,L7 and L13 at 5 cm, 7 cm and 13cm above LES, and U1 ,U6,U8 at 1 cm,6 cm and 8 cm below upper esophageal sphincter（UES）. Detection of Helicobacter pylori infection was conducted in all patients. Results There was no difference in 24h esophageal pH monitoring and De-Meester points between RE and NERD （P 〉 0. 05 ）. Among slight, midium, and severe GERD ： there were difference at 24h esophageal pH monitoring（P 〈0. 01 ）. There was no difference of esophageal acid exposure, LESP and esophageal body contraction amplitude （ LS, L7, L12, U6 and U8 ） between RE and NERD （ P 〉 0. 05 ）, RE patients have a lower pressure monitoring than NERD patients at U1 （P 〈0. 05）. Among slight, midium, and severe GERD patients,there were no difference in LESP, esophageal body contraction amplitude monitoring （ P 〉 0. 05 ）, The positive rate of Helicobacter pylori infection was 16. 1% and 22. 2% in RE and NERD respectively （P 〉 0. 05 ）. OR was 1. 309 （95% C1：0. 364-4, 705 ）. Conclusion There were no differences of esophageal acid exposure, LESP and esophageal body contraction amplitude between RE and NERD patients, and acid regurgitation can not be served as the determinator in NERD. Key words: Gastroesophageal reflux disease; Reflux esophagitis; Non-erosive reflux disease; Ambulatory 24h esophageal pH monitoring; Stress test