Exploring esophagogastric junction morphology and contractile integral: implications for refractory gastroesophageal reflux disease pathophysiology

被引:0
|
作者
Lin, Sihui [1 ]
Chen, Zhilong [1 ]
Jiang, Wei [1 ,2 ]
Zhu, Yucheng [1 ]
机构
[1] Fudan Univ, Zhongshan Hosp, Dept Gastroenterol & Hepatol, Xiamen Branch, 668 Jinhu Rd, Xiamen 361015, Peoples R China
[2] Fudan Univ, Zhongshan Hosp, Dept Gastroenterol & Hepatol, Shanghai, Peoples R China
基金
中国国家自然科学基金;
关键词
Esophagogastric junction; gastroesophageal reflux; high resolution manometry; reflux monitoring; lower esophageal sphincter; HIGH-RESOLUTION MANOMETRY; HIATAL-HERNIA;
D O I
10.1080/00365521.2025.2450042
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
Background: Evaluate the clinical significance of esophagogastric junction (EGJ) morphology and esophagogastric junction contractile integral (EGJ-CI) in refractory gastroesophageal reflux disease (RGERD) patients. Methods: From June 2021 to June 2023, 144 RGERD patients underwent comprehensive evaluation, recording symptom scores, demographic data. GERD classification (NERD or RE, A-D) was based on endoscopic findings. Reflux was assessed through 24-hour pH-impedance monitoring, and high-resolution esophageal manometry(HREM) measured parameters including EGJ-CI. Results: HREM revealed EGJ morphologies (type I, II, III) in 80.6%, 13.9%, and 5.6% of subjects, respectively. As the separation between the lower esophageal sphincter(LES) and crural diaphragm(CD) increased, EGJ-CI decreased (p < 0.005). Subjects with EGJ morphology types II and III had significantly higher acid exposure times(AET), DeMeester scores, and impedance reflux times than type I (p < 0.05). There was no statistical difference between types II and III. Impedance reflux times in subjects with type III morphology were significantly higher than those with types I and II (p < 0.05). The optimal EGJ-CI cutoff for distinguishing pathological reflux was 24.8 mmHg<middle dot>cm, with 68% sensitivity, 72.3% specificity, and an AUC of 0.693 (95% CI 0.609-0.768). Logistic regression analysis identified EGJ-CI <24.8 mmHg<middle dot>cm (OR = 2.5, 95% CI 1.1-5.5, p = 0.022) and ineffective esophageal motility(IEM) (OR = 2.4, 95% CI 1.2-5.2, p = 0.027) as independent risk factors. Conclusion: EGJ-CI is crucial for clinically assessing EGJ barrier function, predicting pathological reflux and selecting patients with persistent reflux symptoms for surgery.
引用
收藏
页码:130 / 135
页数:6
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