Clinical and morphological features and functional parameters in patients with gastroesophageal reflux disease and Barrett's esophagus

• Published in: Терапевтический архив
• Main Authors: Alexander S. Trukhmanov, Anna V. Paraskevova, Olga A. Storonova, Andrey B. Ponomarev, Anastasia A. Makushina, Vladimir T. Ivashkin
• Format: Article
• Language: Russian
• Published: "Consilium Medicum" Publishing house 2025-01-01
• Subjects: gerd; metaplasia; barrett’s esophagus; esophageal manometry; 24-hour impedance ph monitoring
• Online Access: https://ter-arkhiv.ru/0040-3660/article/viewFile/681969/205479
• ISSN: 0040-3660; 2309-5342

Aim. To develop a treatment strategy based on the analysis of clinical manifestations and the results of morphofunctional diagnostics for patients with gastroesophageal reflux disease (GERD) aimed at preventing the development and progression of intestinal metaplasia (IM) of the esophageal epithelium. Materials and methods. The study included 50 subjects diagnosed with GERD. After esophagogastroduodenoscopy with biopsy and subsequent morphological examination of the esophageal mucosa, two groups were formed: patients with GERD complicated by IM, also known as Barrett’s esophagus (n = 19), patients with GERD without IM (n = 31). All participants underwent high-resolution esophageal manometry and 24-hour impedance pH monitoring. Results. The study found that in patients with GERD complicated by IM, complaints of intense heartburn and difficulty swallowing occurred more often than in patients with GERD without IM. According to manometry, the resting pressure of the lower esophageal sphincter in patients with GERD and IM (15.1 [1.3; 36.4] mmHg) was lower than in patients with GERD without IM (20.3 [5.5; 42.1] mmHg). This difference was statistically significant (p = 0.002). In patients with GERD and IM, esophageal motility is less effective; this was translated in a decrease in the distal contractile integral of the esophagus to 276.5 [0.2; 567.7] mmHg × s × cm, while in patients with GERD without IM, it was much higher: 942.5 [47.3; 3759.7] mmHg × s × cm. Difficulties in swallowing were associated with a reduced effectiveness of esophageal motility. In patients with GERD complicated by IM, more acid gastroesophageal refluxes were observed compared to patients without IM (72.5 [53.5; 91.5] vs 54.2 [29.9; 78.3]; p = 0.036). They also have a greater percentage of time with pH 4.0 in the esophagus (14.5 [9.7; 19.3] vs 10.3 [5.6; 14.9]; p = 0.028) and higher DeMeester index values (35.4 [1.9; 114.5] vs 15.1 [0.2; 47.7]; p = 0.004). Conclusion. GERD is a multifactorial disease with a primary impairment of the motor function of the upper gastrointestinal tract. The acidic reflux may affect the development of the intestinal type of epithelial metaplasia.