Objective: To analyze esophageal motility dysfunction in gastroesophageal reflux disease (GERD) with different severity of esophagitis, and the relationship between the esophageal motility dysfunction and the severity of esophagitis. Methods: GERD patients simultaneously undergone endoscopy and high-resolution manometry were divided into four groups: Non-esophagitis (Non-erosive gastroesophageal reflux disease, NERD) group, mild esophagitis group, moderate esophagitis group and severe esophagitis group. The gender and age were matched for each group, and every group consisted of 80 cases. Nonparametric test was used to analyze the differences in HRM parameters, such as upper esophageal sphincter (UES) pressure, lower esophageal sphincter (LES) pressure, LES length, LES-CD (crural diaphragm) separation distance, and the percentage of failed peristalsis of the four groups, and the differences between each two of the groups were also analyzed. Results: Nonparametric test showed that the LES pressure and length decreased with the severity of esophagitis, and there were statistical differences (P<0.001, P=0.030). The failed peristalsis percentage increased with the severity of esophagitis and the difference was statistically significant (P<0.001). The LES-CD separation distance was increased with the severity of esophagitis and had statistically significance (P<0.001). When comparing the differences between each two of the groups, there were significant differences (P<0.001, P=0.012, P<0.001, P<0.001) between NERD group and severe esophagitis group in the HRM parameters of the lower esophageal sphincter pressure, the LES length, the LES-CD separation distance, and the percentage of ineffective swallowing in the NERD and severe esophagitis group. The detection rate of HH was significantly increased from NERD to severe esophagitis, the detection rate of HH was 6.3% to 82.5% in gastoracopy and 16.3% to 45.0% in HRM, and the diagnostic consistency was fair (Kappa Value: 0.31). Conclusions: Hypo-dynamic state of esophageal and HH are the main motility characteristics of erosive gastroesophageal reflux disease, Esophageal motility abnormalities increase in parallel with the severity of GERD from NERD to severe esophagitis, these motility disorders may also play important roles in causing esophagitis.
目的： 分析胃食管反流病(GERD)患者不同严重程度食管炎的食管动力学功能障碍情况，以及食管炎严重程度与食管动力学功能障碍之间的关系和意义。 方法： 将同期行胃镜和高分辨率测压(HRM)的GERD患者按食管炎洛杉矶分型分为非糜烂性胃食管反流病(NERD)组、轻度食管炎组、中度食管炎组和重度食管炎组，各组性别和年龄进行配对，每组各均为80例。非参数检验分析各组上食管括约肌压力、下食管括约肌(LES)压力、LES长度、LES与膈肌脚(CD)高压带距离、以及无效吞咽百分比等HRM参数的差异，并进行两两比较。 结果： LES压力及长度食管随食管炎严重程度的升高而减小，差异有统计学意义(P<0.001，P＝0.030)，食管无效吞咽百分比随食管炎严重程度的升高而升高，差异有统计学意义(P<0.001)，LES与CD高压带距离随食管炎严重程度的升高而升高，差异有统计学意义(P<0.001)。四组间两两比较显示NERD与重度食管炎组的LES压力、LES长度、LES与CD高压带距离、以及无效吞咽百分比等HRM参数的差异均有统计学意义(P<0.001，P＝0.012，P<0.001，P<0.001)。从NERD至重度食管炎食管的裂孔疝(HH)检出率明显升高，胃镜的HH检出率为6.3%～82.5%，HRM的HH检出率为16.3%～45.0%，二者的诊断一致性一般(Kappa值为0.31)。 结论： 食管低动力状态和HH是食管炎患者的主要食管动力学表现，食管体部功能低下、LES压力低下和HH与食管炎的严重程度相平行，这些异常可能是造成食管炎的重要因素。.
Keywords: Esophagitis; Gastroesophageal junction; Gastroesophageal reflux disease; Gastroscopy; Hiatal hernia; High-resolution manometry.