Esophageal motility characteristics in gastroesophageal reflux disease patients with or without dysphagia

Abstract

Objective To investigate esophageal motility characteristics in gastroesophageal reflux disease (GERD) patients with or without dysphagia by high-resolution manometry and 24 h esophageal pH monitoring. Methods From August 2012 to November 2015, GERD patients with symptoms of acid reflux and heart burn who received 24 h esophageal pH monitoring were collected. The differences in esophageal motility were further analyzed between the GERD patients with dysphagia and without dysphagia. Student′s t test, χ2 test and Fisher′s exact test were performed for comparison analysis. Results A total of 194 patients received 24 h esophageal pH monitoring and diagnosed as GERD, and at the same period completed esophageal high-resolution manometry.Among them, there were 17 GERD patients (8.8%) with dysphagia and 177 patients (91.2%) without dysphagia. The main classification of esophageal motility disorder of GERD patients with dysphagia was severe esophageal motility disorders (5/17), but the motility type of GERD patients without dysphagia patients mainly was mild esophageal motility disorders (10.2%, 18/177). The integrated relaxation pressure, residual pressure of lower esophageal sphincter (LES), and contraction range at 3 cm and 11 cm above LES of GERD patients with dysphagia were all higher than those of patients without dysphagia ((9.70±0.98) mmHg (1 mmHg=0.133 kPa) vs (7.02±0.30) mmHg, (12.75±1.35) mmHg vs (9.18±0.42) mmHg, (106.80±11.97) mmHg vs (70.82±3.48) mmHg, (82.66±10.70) mmHg vs (56.93±3.11) mmHg), and the differences were statistically significant (t=2.601, 2.488, 2.887, 2.308, all P<0.05). Distal esophageal contraction integral score of GERD patients with dysphagia was significantly higher than that of GERD patients without dysphagia ((2 128.94±310.47) mmHg·cm·s vs (1 029.88±90.16) mmHg·cm·s), and the difference was statistically significant (t=3.400, P=0.001). However, residual pressure of upper esophageal sphincter was significantly lower than that of patients without dysphagia ((2.84±1.21) mmHg vs (6.18±0.38) mmHg, t=-2.650, P=0.009). Conclusions Esophageal motility disorder of GERD patients with dysphagia is severer than that of patients without dysphagia. High resolution esophageal manometry can provide objective evidence of esophageal dynamics of GERD patients, which can guide the diagnosis and treatment of GERD. Key words: GERD; High resolution esophageal manometry; Esophageal motility disorders