[Barrier function of esophagogastric junction in patients with gastroesophageal reflux disease]

To investigate the barrier function of esophagogastric junction (EGJ) in the patients with gastroesophageal reflux diseases (GERD).

Ninety-six GERD patients and 18 healthy subjects (HSs) underwent esophageal manometry. Forty-two of the 96 patients were with reflux esophagitis (RE) and were divided into 2 subgroups according to the LA typing: 31 subgroup of LA-A or B (n = 31), and subgroup of LA-C or D (n = 11). Fifty-four of the 96 patients suffered from non-erosive reflux disease (NERD) and were divided into 2 subgroups based on 24 h esophageal pH monitoring: 31 patients with normal acid exposure (pH < 14.72 according to DeMeester scoring) and 23 with excessive acid exposure (pH > 14.72). The EGJ functions, including lower esophageal sphincter pressure (LESP), crura of diaphragm pressure (CDP), esophagogastric junction pressure (EGJP, sum of LESP and CDP), and post-lower esophageal sphincter relaxation pressure (post-LESRP), and the contractive pressure of esophageal body, including proximal esophageal contractive pressure (PECP) and distal esophageal contractive pressure (DECP), were measured.

The levels of LESP, CDP, EGJP, and post-LESRP of the RE patients were (8 +/- 3), (13 +/- 7), (20 +/- 9), and (31 +/- 13) mm Hg respectively, all significantly lower than those of the NERD patients [(9 +/- 3), (18 +/- 6), (28 +/- 8), and (39 +/- 15) mm Hg, all P < 0.05]. The levels of LESP and post-LESRP of the NERD patients were significantly lower than those of the HSs [(32 +/- 7) and (50 +/- 15) mm Hg, both P < 0.05], however, the levels of CDP and EGJP of the NERD patients were both not significantly different from those of the HSs [(16 +/- 6) and (32 +/- 7) mm Hg, both P > 0.05]. The PECP and DECP of the RE and NERD patients were all significantly lower than those of the HSs (all P < 0.05), however, there were not significant differences in DECP and PECP between the RE and NERD patients (both P > 0.05). Among the NERD patients there were not significant differences in the PECP and DECP between the LA-A and B subgroup and RE LA-C and D subgroup, and among the NERD patients there were not significant differences in PECP and DECP between the subgroups with and without excessive esophageal acid exposure (all P > 0.05).

The EGF anti-reflux function of the GERD patients is impaired. The function of crura of diaphragm of the NERD patients is almost normal, however, that of the RE patients is impaired. NERD and RE have different path physiological basis.