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Effect of hiatal hernia on esophageal manometry and pH-metry in gastroesophageal reflux disease

  • Esophageal, Gastric, and Duodenal Disorders
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Abstract

An increased frequency of reflux events and a prolonged acid clearance have been shown in gastroesophageal reflux (GER) patients with a hiatal hernia as compared to those without. The objective of the present study was to further investigate esophageal motility and patterns of reflux in GER patients, in relation to the presence or absence of hiatal hernia. Esophageal manometry and ambulatory 24-hr esophageal pH-metry were used in 42 patients with GER and 18 controls. Eighteen of the patients were considered to have a nonreducing hiatal hernia on endoscopy. Hiatal hernia patients showed a higher extent of reflux (total composite score,P=0.016; total reflux time,P=0.008, reflux time in supine position,P=0.024; reflux time in upright position,P=0.008), a lower frequency of reflux events (P=0.005), a more severe esophagitis on endoscopy (P<0.01) and a lower amplitude of peristalsis at 5 cm proximal to LES (P=0.0009) as compared to patients without hiatal hernia. The amplitude of peristalsis at the distal esophagus was inversely related to the extent of reflux (P=0.024). Acid clearance was also significantly prolonged in the hernia subgroup (P=0.011). Although LES resting pressure did not differ significantly between the two subgroups of patients, it was inversely related to the extent of reflux in the patients with hiatal hernia (P=0.0005). It is concluded, that GER patients with hiatal hernia present with an increased amount of reflux and more severe esophagitis, which results in more severely impaired esophageal peristalsis as compared to patients without hernia. Prolonged acid clearance and impaired esophageal emptying observed in patients with hiatal hernia could be the result of both the presence of the hernia itself and the reduced peristaltic activity of the esophagus.

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References

  1. Cohen S, Harris LD: Does hiatus hernia affect competence of the gastroesophageal sphincter? N Engl J Med 284:1053–1056, 1971

    Google Scholar 

  2. Wienbeck M, Barnert, J: Epidemiology of reflux disease and reflux esophagitis. Scand J Gastroenterol 24(suppl 156):7–13, 1989

    Google Scholar 

  3. Palmer, ED: The hiatus-esophagitis-esophageal stricture complex: Twenty year prospective study. Am J Med 44:566–579, 1968

    Google Scholar 

  4. Dodds WJ, Dent J, Hogan WJ, Helm JF, Hauser R, Patel GK, Fpide MS: Mechanisms of gastroesophageal reflux in patients with reflux esophagitis. N Engl J Med 307:1547–1552, 1982

    Google Scholar 

  5. Skinner DB: Pathophysiology of gastroesophageal reflux. Ann Surg 202:546–556, 1985

    Google Scholar 

  6. Gill RC, Bowes KL, Murphy PD, Kingma YJ: Esophageal motor abnormalities in gastroesophageal reflux and the effects of fundoplication. Gastroenterology 91:364–369, 1986

    Google Scholar 

  7. Kasapidis P, Xynos E, Mantides A, Chrysos E, Demonakou M, Nikolopoulos N, Vassilakis JS: Differences in manometry and 24 hour ambulatory pHmetry between patients with and without endoscopic or histological esophagitis. Am J Gastroenterol 88:1893–1899, 1993

    Google Scholar 

  8. McCallum RW, Berkowitz DM, Lerner E: Gastric emptying in patients with gastroesophageal reflux. Gastroenterology 80:285–291, 1981

    Google Scholar 

  9. Vassilakis JS, Xynos E, Kasapidis P, Chrysos E, Mantides A, Nicolopoulos N: The effect of floppy Nissen fundoplication on esophageal and gastric motility in gastroesophageal reflux. Surg Gynecol Obstet 177:608–616, 1993

    Google Scholar 

  10. Wright RA, Hurwitz AL: Relationship of hiatal hernia to endoscopically proved reflux esophagitis. Dig Dis Sci 24:311–313, 1979.

    Google Scholar 

  11. Ben Rejeb M, Bouche O, Zeitoun P: Study of 34 consecutive patients with esophageal stricture compared with 3880 cases of reflux esophagitis. Dig Dis Sci 37:733–736, 1992

    Google Scholar 

  12. Sontag SJ, Schnell TG, Miller TQ, Nemschausky B, Serlovsky R, O'Connell S, Ghejfec G, Seidel UJ, Brond L: The importance of hiatal hernia in reflux esophagitis compared with lower esophageal sphincter pressure or smoking. J Clin Gastroenterol 13:628–643, 1991

    Google Scholar 

  13. Sloan S, Kahrilas PJ: Impairment of esophageal emptying with hiatal hernia. Gastroenterology 100:596–605, 1991

    Google Scholar 

  14. Sloan S, Rademaker AW, Kahrilas PJ: Determinants of gastroesophageal junction incompetence: hiatal hernia, lower esophageal sphincter, or both. Ann Intern Med 117:977–982, 1992

    Google Scholar 

  15. Johnson LF, DeMeester TR, Haggitt RC: Endoscopic sings of gastroesophageal reflux objectively evaluated. Gastrointest Endosc 22:151–155, 1976

    Google Scholar 

  16. Mittal RK, Lange RC, Mc Callum RW: Identification and mechanism of delayed esophageal acid clearance in subjects with hiatus hernia. Gastroenterology 92:130–135, 1987

    Google Scholar 

  17. Stene-Larsen G, Weberg R, Frøyshow Larsen I, Bjørtuft Ø, Hoel B, Berstad A: Relationship of overweight to hiatus hernia and reflux oesophagitis. Scand J Gastroenterol 23:427–432, 1988

    Google Scholar 

  18. Savary M, Miller G: Der Osophagus, Lehrbuch und Endoskopischer Atlas. Solothurn, Verlag Gassman AG, 1977, pp 135–139

    Google Scholar 

  19. Johnson LF, DeMeester TR: Development of the twenty-four-hour intraesophageal pH monitoring composite scoring system. J Clin Gastroenterol 8:52–58, 1986

    Google Scholar 

  20. Clark MD, Rinaldo JA, Eyler WR: Correlation of manometric and radiological data from the esophagogastric area. Radiology 94:261–270, 1979

    Google Scholar 

  21. Ott DJ, Gelfand DW, Wu WC, Castell DO: Esophagogastric region and its rings. Am J Radiol 142:281–287, 1984

    Google Scholar 

  22. Dodds WJ, Hogan WJ, Helm JF, Dent J: Pathogenesis of reflux esophagitis. Gastroenterology 81:376–394, 1981

    Google Scholar 

  23. Wright RA, Hurwitz AL: Relationship of hiatal hernia to endoscopically proved reflux esophagitis. Dig Dis Sci 24:151–155, 1979

    Google Scholar 

  24. Berstad A, Weberg R, Larsen IF, Hoel B, Hauer-Jensen M: Relationship of hiatal hernia to reflux esophagitis: a prospective study of coincidence, using endoscopy. Scand J Gastroenterol 21:55–58, 1986

    Google Scholar 

  25. Branicki FJ, Evans DF, Jones JA, Ogilvic AL, Atkinson M, Hardcastle JD: A frequency-duration index for the evaluation of ambulatory recordings of gastroesophageal reflux. Br J Surg 71:425–430, 1984

    Google Scholar 

  26. Rokkas T, Sladen GE: Ambulatory esophageal pH recording in gastroesophageal reflux: Relevance to the development of esophagitis. Am J Gastroenterol 83:629–632, 1988

    Google Scholar 

  27. Pujol A, Grande L, Ros E, Pera C: Utility of inpatient 24-hour intraesophageal pH monitoring in diagnosis of gastroesophageal reflux. Dig Dis Sci 33:1134–1140, 1988

    Google Scholar 

  28. Stein HJ, Eypasch EP, DeMeester TR, Smyrk TC, Attwood EA: Circadian esophageal, motor function in patients with gastroesophageal reflux disease. Surgery 108:769–778, 1990

    Google Scholar 

  29. Moghissi K: Intrathoracic fundoplication for reflux stricture associated with short esophagus. Thorax 38:36–40, 1983

    Google Scholar 

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Kasapidis, P., Vassilakis, J.S., Tzovaras, G. et al. Effect of hiatal hernia on esophageal manometry and pH-metry in gastroesophageal reflux disease. Digest Dis Sci 40, 2724–2730 (1995). https://doi.org/10.1007/BF02220466

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  • DOI: https://doi.org/10.1007/BF02220466

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