Study for the Pathogenesis of Reflux Esophagitis Using 24-Hou Ambulatory Manometry and pH-metry

Shim, Chan Sup; Lee, Joon Seong; Kim, Yun Soo; Lee, Moon Sung; Cho, Joo Young; Hwang, Seong Gyu; Cho, Young Deok; Choi, Woo Bong; Ham, Jeung Sik; Jang, Jae Young; Hong, Su Jin; Moon, Jong Ho; Kim, Jin Oh

Abstract

BACKGROUND AND AIMS: There are still controversies on the pathogenesis of the development of esophagitis in patients with gastroesophageal reflux disease (GERD). The aim of this study was to evaluate the reflux characteristics in esophagitis GERD patients and non-esophagitis GERD patients.
METHODS
Forty one patients with typical reflux symptoms more than 6 months and an abnormal 24 hour ambulatory pH monitoring were enrolled. Eighteen patients had esophagitis on endoscopic examination and 23 did not. All patients performed 24 hour ambulatory pH and pressure monitoring after standard esophageal manometry.
RESULTS
The mean GER pH and the mean peak of GER pH in esophagitis GERD patients (Group A) and non-esophagitis GERD patients (Group B) showed no difference (pH 3.6+/-0.2, 2.9+/-0.3 vs pH 3.7+/-0.3, 3.1+/-0.5) respectively. The mean duration of GER in Group A showed longer tendency than that of Group B, but failed to show statistical difference (64.4+/-51.0 seconds vs 43.0+/-26.9 seconds). The number of reflux episode > 5 min of GER in Group A and B showed no difference (3.78+/-2.78 vs 3.36+/-3.86) The mean percent of peristaltic contraction of esophageal body was significantly decreased in Group A compared with Group B (59.7+/-15.1% vs 67.8+/-7.8%, p<0.05), and mean percent of isolated contraction was significantly increased in Group A compared with Group B (20.3+/-17.1% vs 9.9+/-7.9%, p<0.05). There was no difference between Group A and B in the mean percent of simultaneous contractions, and mean percent of retrograde contractions. The LES pressure of Group A was significantly lower than that of Group B (18.0+/-7.9 mmHg vs 24.6+/-9.8 mmHg, p<0.05). There was no difference between Group A and B in the DeMesster score (31.9+/- 14.3 vs 40.6+/-40). There was no difference between Group A and B in amplitude of esophageal body.
CONCLUSIONS
The esophagitis GERD patients showed decreased peristaltic contraction and increased isolated contraction of esophageal body compared to non-esophagitis GERD patients. It suggests that motility disorder plays a major role in the pathogenesis of esophagitis in GERD patients.