Ledovskaya A., Sablin O.A. The pathogenetic implication of secondary oesophageal peristalsis impairments in patients with gastroesophageal reflux disease / 2012 Joint Intern. Neurogastroenter. and Motility Meeting, 6–8.10.2012, Bologna, Italy. PP. 175.

The pathogenetic implication of secondary oesophageal peristalsis impairments in patients with gastroesophageal reflux disease A. Ledovskaya, O.A. Sablin, Russia

Objective

To determine the pathogenetic implication of secondary oesophageal peristalsis impairments in patients with gastroesophageal reflux disease (GERD).

Methods

145 patients with GERD and 22 virtually healthy individuals were evaluated. The diagnosis of GERD was based on characteristic clinical data and endoscopic signs of reflux oesophagitis, as well as on results of 24-hour oesophageal pH monitoring using "Gastroscan-24" device. Oesophageal motility was studied in all study subjects by means of intracavitary impedance monitoring with a Rheogastrograph RGG9-01 device (Saint Petersburg) working at frequency of 10Hz, in dynamic mode, before and after functional acid test. An impedance monitoring probe connected in advance to a polyvinylchloride tube (diameter, 1 mm) was introduced into the oesophagus.We used the tube to inject 5 mL of 0.1n hydrochloric acid solution pre-heated to 37⁰С into the lower one-third of oesophagus.

Results

Oesophagogastroscopy revealed endoscopy-negative GERD in 5.7% of study subjects. Reflux oesophagitis grade A was found in 63.0% of patients, grade B in 22.7%, grade C in 7.0%, grade D in 1.7%. Barrett’s oesophagus was seen in 3.8% of cases, and bleeding in 0.4%. Results of 24-hour oesophageal pH monitoring were utilized to divide all study subjects into two groups according to distal oesophageal acidity (proportion of time with distal oesophageal рН less than 4 units within 24 hours). Normal 24-hour proportions of рН<4 time were obtained for 20.7% of GERD patients, while those exceeding 4.5% were observed in 79.3%.

Secondary oesophageal peristalsis (SOP) was preserved in 31.7% of patients with GERD, while it was undetectable in 17.2%. Increased baseline oesophageal motility was observed in 30.4% of subjects. The most severe grades of reflux oesophagitis (A,B,C) were more frequently (p<0.05) observed in GERD patients with SOP impairment. Extra-oesophageal manifestations of the disease (pharyngitis, laryngitis, cough) were identified only in patients with pathological gastroesophageal reflux, more commonly (p<0.05) in patients with abnormal SOP.

Conclusion

Impairment of secondary oesophageal peristalsis is one of the most important pathogenetic mechanisms in the development of extra-oesophageal clinical manifestations and pathomorphological abnormalities of oesophageal mucous membrane in patients with GERD and Barrett’s oesophagus.

Ledovskaya A., Sablin O.A. The pathogenetic implication of secondary oesophageal peristalsis impairments in patients with gastroesophageal reflux disease / 2012 Joint International Neurogastroenterology and Motility Meeting, 6–8 September 2012, Bologna, Italy. Poster Presentation 175.