The characteristics of the gastroesophageal junction in gastroesophageal reflux disease under high–resolution esophageal manometry

Abstract

Objective To analyze the characteristics of gastroesophageal junction(GEJ) in gastroesophageal reflux disease(GERD) using high resolution manometry(HRM), and the features in different GERD subtypes, reflux esophagitis(RE) and non–erosive gastrooesophageal reflux disease(NERD). Methods Sixty GERD patients were divided into two subtypes, RE(n=33) and NERD(n=27), based on the results of endoscopy. All patients received HRM, and were divided into three subtypes, typeⅠ, type Ⅱ and type Ⅲ according to the GEJ pressure morphology. HRM results among different subtypes were investigated. Results In 60 GERD patients, the GEJ was divided into three subtypes, including 26 cases of typeⅠ(RE=14, NERD=12), 29 cases of typeⅡ(RE=14, NERD=15) and 5 cases of type Ⅲ(RE=5). The characteristics of GEJ morphologic subtypes were analyzed. The total length of lower esophageal sphincter(LES) of three GEJ subtypes(typeⅠ, typeⅡ and type Ⅲ) were(3.35±0.56)cm, (3.29±0.87)cm and(2.43±0.22)cm, respectively. The LES intra–abdominal length of three GEJ subtypes were(2.41±0.68)cm, (3.07±4.59)cm and(0.00±0.00)cm, respectively. The LES rest pressure of three GEJ subtypes were(22.00±8.00)mmHg, (16.46±8.60)mmHg and(11.07±5.80)mmHg, respectively. The total length of LES were significantly different among three subtypes(P 0.05). Among type I and type II patients, there were no significant difference in LES–CD distance, total length of LES, LES intra–abdominal length and LES rest pressure between RE group and NERD group. Conclusion HRM can clearly distinguish the GEJ subtypes. To some extent, esophageal motility characteristics of the patients with different subtypes GEJ is various. However, it still needs further studies with larger sample size to confirm. Key words: Gastroesophageal reflux disease; High resolution manometry; Gastroesophageal junction