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Hiatal hernia and gastroesophageal reflux: Study of collagen in the phrenoesophageal ligament

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Abstract

Background

Gastroesophageal reflux disease (GERD) is defined by the intensity and/or quality of the reflux of gastric or duodenal contents into the esophagus. Surgical treatment of GERD has shown conflicting results and unacceptable recurrence rates, mainly due to herniation of the antireflux valve into the chest. A variety of techniques has been proposed to reduce GERD recurrence, including routine use of prosthesis in cruroplasty. The prevalence of GERD in patients with hiatal hernia (HH) can reach 94 %. It is possible that the phrenoesophageal ligament (POL) engaged in the stabilization of the gastroesophageal junction in the abdomen may be an etiological factor of HH. We conducted a study to evaluate collagen in the constitution of the POL in patients with HH and cadavers without HH.

Methods

POL samples were collected from 29 patients with HH and GERD (cases) and 32 samples from cadavers without HH (controls). Total collagen was quantified through the Picrosirius red histochemical technique, and type-I and type-III collagens were quantified immunohistochemically using a monoclonal antibody. The stained slides were photographed, and images were quantified by computer software (Image Pro Plus) to count the pixels per field.

Results

The mean age was 49.5 (±11.5) years for the cases and 38.5 (±13) years for the controls (p < 0.01). Seventeen cases (58.6 %) and six controls (18.75 %) were female (p < 0.01). The quantity of total (p < 0.01), type-I (p < 0.01), and type-III (p < 0.05) collagens was significantly lower by about 60 % in patients with HH compared with controls.

Conclusion

Our data indicate that the composition of POL for patients with GERD and HH includes less total, type-I, and type-III collagens than that of the POL of cadavers without HH. The quality of the POL may be an etiological factor in the development of HH.

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Acknowledgments

This work was funded by the Research and Events Incentive Fund (FIPE) of the Hospital de Clinicas of Porto Alegre. We thank Drª Luise Meurer for analysis of biopsies of this study.

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Authors and Affiliations

  1. Digestive Surgery Service, Hospital de Clínicas of Porto Alegre, Ramiro Barcelos, 2350. 7º Floor/Room 743, Porto Alegre, RS, CEP 90035-903, Brazil

    V. von Diemen & E. N. Trindade

  2. Department of Surgery, Federal University of Rio Grande do Sul, Ramiro Barcelos, 2400, Porto Alegre, Rio Grande do Sul, Brazil

    M. R. M. Trindade

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  1. V. von Diemen
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Correspondence to V. von Diemen.

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Dr. Vinicius von Diemen, Dr. Eduardo N. Trindade, and Dr. Manoel R. M. Trindade have no conflicts of interest or financial ties to disclose.

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von Diemen, V., Trindade, E.N. & Trindade, M.R.M. Hiatal hernia and gastroesophageal reflux: Study of collagen in the phrenoesophageal ligament. Surg Endosc 30, 5091–5098 (2016). https://doi.org/10.1007/s00464-016-4858-1

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