Ineffective esophageal motility in GERD with respiratory symptom

Objective To observe the type and prevalence of esophageal motility abnormality in patients with respiratory symptom.And to investigate the effect and clinical significance of ineffective esophageal motility(IEM)in the pathogenesis of GERD with respiratory symptom.Methods In the thirty-four GERD patients with respiratory symptoms of asthma,chronic cough,complaint of laryngeal pharynges,the esophageal manometry and 24 hour esophageal pH monitoring were performed by Multiple Functional Gastrointestinal Motility Monitor made by MMS,Holland.The peristaltic velocity,amplitude and duration of esophageal body and lower esophageal sphincter(LES)pressure was detected.Computer software was used to analyze pH monitoring result,including the percentage of pH4,percentage of pH 4 in upright and supine position,average esophageal acid clearance time(the time of pH4/peroid of acid reflex),and calculate DeMeester score.Results The LES and peristaltic amplitudes of proximal and distal esophagus had no statistic difference(P0.05)between GERD patients with respiratory symptom group and normal control group.In the group of GERD patients with respiratory symptom,main abnormal esophageal motility type was IEM,the prevalance of IEM(41.2%)being significantly higher than that in group of typical reflux symptom GERD(18.5%)and normal control group(0).In 34 GERD patients with respiratory symptom,24 hour esophageal pH monitoring result of IEM group and normal esophageal motility group was analyzed:the total percentage of pH4 and percentage of pH4 in upright and supine position in the group of patient with IEM was much higher than the group of normal esophageal motility.Esophageal acid clearance time in supine position in the group of IEM was much longer than the group of normal esophageal motility.Conclusion In GERD patients with respiratory symptom,there is no significant difference in the LES pressure and distal esophagus peristaltic amplitude,compared to GERD patient with typical reflex symptom and normal control group,and their main abnormal esophageal motility type is IEM(41.2%).Total esophagus exposure time both in supine and upright position and esophageal acid clearance time in supine position in the group of IEM patients are significantly longer than that in normal esophageal motility group.It shows that IEM is very important in the pathogenesis of GERD patients with respiratory symptom.