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Sachar M, Mautner Wizentier M, Risner E, Asmail H, Omara M, Chablaney S, Khan A, Knotts R. Risk factors associated with functional esophageal disorders (FED) versus gastroesophageal reflux disease (GERD). Surg Endosc 2024; 38:2842-2849. [PMID: 38528263 DOI: 10.1007/s00464-024-10714-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Accepted: 01/28/2024] [Indexed: 03/27/2024]
Abstract
INTRODUCTION Despite the high prevalence of typical symptoms of gastroesophageal reflux disease (GERD), approximately 30% of patients have functional esophageal disorders (FED) on ambulatory reflux monitoring, which may include reflux hypersensitivity (RH; defined as physiologic acid exposure but temporally correlated symptoms of reflux), or functional heartburn (FH; defined as physiologic acid exposure and negative symptom correlation). There are limited epidemiological data characterizing these conditions. We investigated demographic and socioeconomic factors as well as medical comorbidities which may predispose to FED versus pathologic GERD. METHODS Adult patients with reflux symptoms for at least 3 months were studied with 24-h pH-impedance testing from 11/2019 to 3/2021. Participants were categorized into pathologic GERD, FH, or RH using pH-impedance data and reported symptom correlation. Demographic data, including age, gender, race/ethnicity, zip code, insurance status, and medical comorbidity data were retrospectively retrieved from the electronic medical record on all participants. RESULTS 229 patients were included. Non-Hispanic Asian ethnicity (OR 5.65; p = 0.01), underweight BMI (OR 7.33; p = 0.06), chronic pain (OR 2.33; p < 0.01), insomnia (OR 2.83; p = 0.06), and allergic rhinitis (OR 3.90; p < 0.01) were associated with a greater risk for FED. Overweight BMI (OR 0.48; p = 0.03) and alcohol use (OR 0.57; p = 0.06) were associated with a decreased risk for FED. DISCUSSION This is the first report of a greater risk of FED in patients with underweight BMI, insomnia, chronic pain, allergic rhinitis, or of Asian or Hispanic ethnicities. The weak associations between female gender and anxiety are corroborated in other studies. Our findings enable clinicians to better screen patients with reflux for this disorder.
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Affiliation(s)
- Moniyka Sachar
- Department of Medicine, New York University Langone Health, 247 E 28th Street, New York, NY, 10016, USA.
| | | | - Emma Risner
- Department of Biostatistics, New York University School of Public Health, New York, USA
| | - Hannah Asmail
- Department of Biostatistics, New York University School of Public Health, New York, USA
| | - Mathew Omara
- Division of Gastroenterology & Hepatology, Department of Medicine, Center for Esophageal Health, NYU Grossman School of Medicine, NYU Langone Health, New York, NY, USA
| | - Shreya Chablaney
- Division of Gastroenterology & Hepatology, Department of Medicine, Center for Esophageal Health, NYU Grossman School of Medicine, NYU Langone Health, New York, NY, USA
| | - Abraham Khan
- Division of Gastroenterology & Hepatology, Department of Medicine, Center for Esophageal Health, NYU Grossman School of Medicine, NYU Langone Health, New York, NY, USA
| | - Rita Knotts
- Division of Gastroenterology & Hepatology, Department of Medicine, Center for Esophageal Health, NYU Grossman School of Medicine, NYU Langone Health, New York, NY, USA
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Hage K, Cornejo J, Allotey JK, Castillo-Larios R, Caposole MZ, Iskandar M, Kellogg TA, Galvani C, Elli EF, Ghanem OM. Feasibility and Outcomes of Simultaneous Gastric Bypass with Paraesophageal Hernia Repair in Elderly Patients. Obes Surg 2023; 33:2734-2741. [PMID: 37454304 DOI: 10.1007/s11695-023-06726-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 06/27/2023] [Accepted: 07/06/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND Paraesophageal hernias (PEH) have a higher incidence in patients with obesity. Roux-en-Y gastric bypass (RYGB) with concomitant PEH repair is established as a valid surgical option for PEH management in patients with obesity. The safety and feasibility of this approach in the elderly population are not well elucidated. METHODS We performed a multicenter retrospective cohort study of patients aged 65 years and older who underwent simultaneous PEH repair and RYGB from 2008 to 2022. Patient demographics, hernia characteristics, postoperative complications, and weight loss data were collected. Obesity-related medical conditions' resolution rates were evaluated at the last follow-up. A matched paired t-test and Pearson's test were used to assess continuous and categorical parameters, respectively. RESULTS A total of 40 patients (82.5% female; age, 69.2 ± 3.6 years; BMI, 39.4 ± 4.7 kg/m2) with a mean follow-up of 32.3 months were included. The average hernia size was 5.8 cm. Most cases did not require mesh use during surgery (92.5%) with only 3 (7.5%) hernial recurrences. Postoperative complications (17.5%) and mortality rates (2.5%), as well as readmission (2.5%), reoperation (2.5%), and reintervention (0%) rates at 30-day follow-up were reported. There was a statistically significant resolution in gastroesophageal reflux disease (p < 0.001), hypertension (p = 0.019), and sleep apnea (p = 0.014). CONCLUSIONS The safety and effectiveness of simultaneous PEH repair and RYGB are adequate for the elderly population. Patient selection is crucial to reduce postoperative complications. Further studies with larger cohorts are needed to fully assess the impact of this surgery on elderly patients with obesity.
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Affiliation(s)
- Karl Hage
- Department of Surgery, Mayo Clinic, Rochester, MN, 55905, USA
| | - Jorge Cornejo
- Department of General Surgery, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL, 32224, USA
| | - Jonathan K Allotey
- Division of Minimally Invasive Surgery and Bariatric, Department of Surgery, Tulane University, 1430 Tulane Ave., LA, 70112, New Orleans, USA
| | - Rocio Castillo-Larios
- Department of General Surgery, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL, 32224, USA
| | - Michael Z Caposole
- Division of Minimally Invasive Surgery and Bariatric, Department of Surgery, Tulane University, 1430 Tulane Ave., LA, 70112, New Orleans, USA
| | - Mazen Iskandar
- Department of Surgery, Baylor Scott and White Medical Center, Waxahachie, TX, 75165, USA
| | - Todd A Kellogg
- Department of Surgery, Mayo Clinic, Rochester, MN, 55905, USA
| | - Carlos Galvani
- Division of Minimally Invasive Surgery and Bariatric, Department of Surgery, Tulane University, 1430 Tulane Ave., LA, 70112, New Orleans, USA
| | - Enrique F Elli
- Department of General Surgery, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL, 32224, USA
| | - Omar M Ghanem
- Department of Surgery, Mayo Clinic, Rochester, MN, 55905, USA.
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Yalaki S, Caglar R, Pulat H. Effect of gastric helicobacter pylori colonization in the development of erosive esophagitis in patients with hiatal hernia. Niger J Clin Pract 2023; 26:43-48. [PMID: 36751822 DOI: 10.4103/njcp.njcp_1928_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Background/Aims There may be various factors that determine gastroesophageal reflux disease (GERD) as a result of hiatal hernia (HH) (such as the size of the hernia, age, other host and environmental factors) and the presence of protective factors to explain the absence of reflux disease should not be ignored. Helicobacter pylori (Hp) infection can prevent the development of GERD or cause it. This study aimed to determine whether Hp colonized in the stomach and hernia affects the development of erosive esophagitis (EE) in patients with HH. Materials and Methods In this case-controlled study, 111 patients with HH were eligible for the study. Study group with EE (n = 61, 55%) and control group without EE (n = 50, 45%) were formed. Groups were compared for gastric Hp and Hp in the hernia. Results While the frequency of Hp in the antrum was 55.7% in the group with EE, it was 30% in the control group (p = 0.01, OR: 2.94 in 95% CI 1.34-6.46). The rates in terms of HP frequency in the corpus were 43.6% and 32.1%, respectively, (p = 0.45). Hp colonization in HH was detected in 18 cases (29.50%) and 14 cases (28%), respectively, (p = 0.86). In regression analysis, antral Hp was found to be effective in the development of EE (p = 0.01). Conclusion As a result of this study, we think that antral Hp may have a causative role in the development of reflux esophagitis, but the presence of Hp in HH does not have an effective role in reflux esophagitis formation.
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Affiliation(s)
- S Yalaki
- Department of Gastroenterology, Mersin City Training and Research Hospital, Mersin, Turkey
| | - R Caglar
- Department of General Surgery, Mersin City Training and Research Hospital, Mersin, Turkey
| | - H Pulat
- Department of General Surgery, Mersin City Training and Research Hospital, Mersin, Turkey
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Yoo IH, Yang HR. Pelvic radiography as a non-invasive screening tool for hiatal hernia in children with cerebral palsy. Medicine (Baltimore) 2022; 101:e29522. [PMID: 35984193 PMCID: PMC9387974 DOI: 10.1097/md.0000000000029522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
The diagnosis of hiatal hernia (HH), causing severe gastroesophageal reflux disease and complications in children with cerebral palsy (CP) is cumbersome because invasive investigations are required for diagnosis. Hip displacement, one of the most common complications in children with CP, can be diagnosed with a simple pelvic radiograph. This study aimed to evaluate the association between the severity of hip displacement and HH and the diagnostic accuracy of Reimers' hip migration percentage (MP) on pelvic radiography in assessing the presence of HH. A total of 52 children with CP (27 boys, 25 girls; mean age, 6.3 years; range, 0.6-17.4 years) who underwent esophagogastroduodenoscopy, upper gastrointestinal series and pelvic radiography between March 2013 and February 2020 were recruited. Demographic and clinical characteristics, as well as endoscopic and radiological findings, were evaluated and statistically analyzed. HH was defined as ≥ 2 cm proximal displacement of the gastroesophageal junction identified in esophagogastroduodenoscopy or upper gastrointestinal series, and MP was calculated by evaluating the pelvic radiograph. Of the 52 children enrolled in this study, HH was diagnosed in 18 children (34.6%). When the patients were classified and analyzed according to the MP result, HH was observed in 10%, 26.7%, and 70.6% in MP <33%, MP 33%-39%, and MP > 40% groups, respectively (P < .001). The optimal MP cutoff of 36.5% distinguished pediatric CP patients with HH from those without HH with a sensitivity of 78%, specificity of 68%, a positive predictive value of 56.0%, and a negative predictive value of 85.2%, respectively. The application of MP and the severity of hip displacement, which can be easily measured by simple radiography, may be useful and reliable in screening for detecting HH in children with CP. Retrospectively registered. This study was approved by the Institutional Review Board of Seoul National University Bundang Hospital (IRB No. B-2007-627-106).
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Affiliation(s)
- In Hyuk Yoo
- Department of Pediatrics, Seoul St. Mary's Hospital, School of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hye Ran Yang
- Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
- *Correspondence: Hye Ran Yang, Department of Pediatrics, Seoul National University Bundang Hospital, Seoul National University, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Korea (e-mail: , )
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Nikaki K, Sifrim D. Pathophysiology of Pediatric Gastroesophageal Reflux Disease: Similarities and Differences With Adults. J Clin Gastroenterol 2022; 56:99-113. [PMID: 34560757 DOI: 10.1097/mcg.0000000000001604] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Gastroesophageal reflux (GOR) is defined as "the passage of gastric contents into the esophagus with or without regurgitation and vomiting" and gastroesophageal reflux disease (GORD) is defined "when GOR leads to troublesome symptoms affecting the daily functioning and/or complications." This definition was first developed in 2006 by the Montreal consensus group (1) and later on adopted by pediatric gastroenterology societies such as ESPGHAN and NASPGHAN in 2009 (2). The definition of gastroesophageal reflux reveals little about its pathophysiology and is focused on symptomatology. In this way, it acts as an umbrella term for the multifactorial causes of the disease and the various phenotypes encountered; from functional heartburn to hypersensitive esophagus and nonerosive reflux disease, to erosive esophagitis and Barrett's esophagus. This article is devoted to the pathophysiology of pediatric GORD in comparison to adult GORD and is divided in 2 parts. In the first part, we will systematically describe the different mechanisms for the generation and clearance of reflux events, while on the second part we will discuss the mechanisms involved in symptoms generation. Finally, we will discuss the similarities and differences between pediatric and adult GORD.
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Affiliation(s)
- Kornilia Nikaki
- Gastroenterology Department, Great Ormond Street Hospital for Children
| | - Daniel Sifrim
- Wingate Institute of Neurogastroenterology, The Blizard Institute, QMUL, London, UK
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Yoo IH, Joo JY, Yang HR. Factors associated with hiatal hernia in neurologically impaired children. Neurogastroenterol Motil 2022; 34:e14158. [PMID: 33837998 DOI: 10.1111/nmo.14158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Revised: 03/15/2021] [Accepted: 03/23/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND Hiatal hernia is clinically important because it impairs the protective mechanism that prevents gastroesophageal reflux-induced injury. Diagnosing hiatal hernia is more important in neurologically impaired children because hiatal hernia-induced gastroesophageal reflux often causes severe complications such as aspiration pneumonia or malnutrition. We aimed to evaluate the patient characteristics and early predictors of hiatal hernia in neurologically impaired children. METHODS We retrospectively investigated 97 neurologically impaired children who underwent esophagogastroduodenoscopy and upper gastrointestinal series between March 2004 and June 2019. Demographic and clinical characteristics, as well as endoscopic and radiological findings, were statistically analyzed. RESULTS Of the 97 children recruited, 22 (22.7%) had hiatal hernia. When comparing the non-hiatal hernia group with the hiatal hernia group, neurological disease longer than 6 months (odds ratio 10.9, 95% confidence interval 1.2-96.5), wasting (odds ratio 4.6, 95% confidence interval 1.3-16.3), enteral tube feeding (odds ratio 9.2, 95% confidence interval 1.6-53.0), and history of aspiration pneumonia (odds ratio 6.5, 95% confidence interval 1.2-34.5) were identified as early predictors of hiatal hernia. CONCLUSIONS Timely identification of predictors of developing hiatal hernia in neurologically impaired children is important for early diagnostic confirmation to initiate optimal medical or surgical treatment of hiatal hernia to avoid serious complications such as aspiration pneumonia and malnutrition.
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Affiliation(s)
- In Hyuk Yoo
- Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jung Yeon Joo
- Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hye Ran Yang
- Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Korea.,Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
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Robot-assisted versus laparoscopic approach to concurrent bariatric surgery and hiatal hernia repair: propensity score matching analysis using the 2015-2018 MBSAQIP. Surg Endosc 2022; 36:6886-6895. [PMID: 35020060 DOI: 10.1007/s00464-022-09027-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 01/03/2022] [Indexed: 10/19/2022]
Abstract
BACKGROUND Up to 37% of class three obesity patients have a Hiatal Hernia (HH). Most of the existent HHs get repaired at the time of bariatric surgery. Although the robotic platform might offer potential technical advantages over traditional laparoscopy, the clinical outcomes of the concurrent bariatric surgery and HH repair comparing robotic vs laparoscopic approaches have not been reported. METHODS Using the 2015-2018 Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database, patients between 18 and 65 year old who underwent Sleeve gastrectomy (SG) or Roux en-Y Gastric Bypass (RYGB) with concurrent HH repair were identified. Demographic, operative, and 30-day postoperative outcomes data were compared between laparoscopic and robotic groups. To adjust for potential confounders, 1:1 propensity score matching was performed using 22 preoperative characteristics. RESULTS 75,034 patients underwent SG (n = 61,458) or RYGB (n = 13,576) with concurrent HH repair. The operative time was significantly longer in the Robotic-assisted compared to the laparoscopic approach both for SG (102.31 ± 44 vs. 75.27 ± 37; P < 0.001) and for RYGB (163.48 ± 65 vs. 132.87 ± 57; P < 0.001). In the SG cohort (4639 matched cases), the robotic approach showed similar results in 30 day outcomes as in the laparoscopic approach, with no statistical difference. Conversely, for the RYGB cohort (1502 matched cases), the robotic approach showed significantly fewer requirements for blood transfusions (0.3% vs. 1.7%; P = 0.001), fewer anastomotic leaks (0.2% vs. 0.8%; P = 0.035), and less postoperative bleeding (0.4% vs. 1.1%; P = 0.049). CONCLUSION Robotic concurrent bariatric surgery and HH repair leads to similar overall clinical outcomes as the laparoscopic approach despite longer operative times. Furthermore, the robotic approach is associated with reduced blood transfusion and anastomotic leak incidence in the RYGB group.
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Rohof WO, Smout AJ. Hiatus Hernia and Gastroesophageal Reflux Disease. THE ESOPHAGUS 2021:347-357. [DOI: 10.1002/9781119599692.ch20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2025]
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Savarino V, Marabotto E, Zentilin P, Furnari M, Bodini G, De Maria C, Tolone S, De Bortoli N, Frazzoni M, Savarino E. Pathophysiology, diagnosis, and pharmacological treatment of gastro-esophageal reflux disease. Expert Rev Clin Pharmacol 2020; 13:437-449. [PMID: 32253948 DOI: 10.1080/17512433.2020.1752664] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Gastro-esophageal reflux disease (GERD) is a highly prevalent, chronic, relapsing disorder, whose knowledge has increased in last years thanks to the advent of new sophisticated techniques, such as 24-h impedance-pH monitoring and high-resolution manometry, for the study of esophageal functions. AREAS COVERED This review provides an overview of our advancements in understanding the complex pathophysiology, improving the diagnosis and defining the modern pharmacological therapeutic approach to GERD. EXPERT OPINION The growing clinical application of impedance-pH testing has allowed us to know the diversity of patients with non-erosive reflux disease (NERD), who nowadays represent about 70% of the whole population with reflux symptoms. We have realized that NERD has to be considered as an umbrella term covering various subgroups with different pathophysiologies. The development of new impedance metrics, in particular mean nocturnal baseline impedance, seems to be promising in the improvement of the diagnostic process of this disease. There are no particularly innovative features in the pharmacological therapy of GERD, unless the interest toward drugs is able to increase the defense properties of esophageal mucosa and/or its protection. These compounds can be of help in combination with proton pump inhibitors in NERD patients with partial response to antisecretory drugs alone.
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Affiliation(s)
| | - Elisa Marabotto
- Department of Internal Medicine, University of Genoa , Genoa, Italy
| | | | - Manuele Furnari
- Department of Internal Medicine, University of Genoa , Genoa, Italy
| | - Giorgia Bodini
- Department of Internal Medicine, University of Genoa , Genoa, Italy
| | | | - Salvatore Tolone
- Department of Surgery, University of Campania "Luigi Vanvitelli" , Naples, Italy
| | - Nicola De Bortoli
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa , Pisa, Italy
| | - Marzio Frazzoni
- Department of Gastroenterology, Gastroenterology Digestive Pathophysiology Unit, Baggiovara Hospital , Modena, Italy
| | - Edoardo Savarino
- Department of Surgery, Oncology and Gastroenterology, University of Padua , Padua, Italy
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Abstract
Minimally invasive endoscopic antireflux therapies are critical for bridging the gap between medical and surgical treatments for gastroesophageal reflux disease (GERD). Although multiple endoscopic devices have been developed, perhaps some of the most exciting options that are currently evolving are the full-thickness suturing techniques using widely available and low-cost platforms. Full-thickness endoscopic suturing can allow for a highly durable recreation of the anatomic and functional components of a lower esophageal sphincter, which are deficient in patients with GERD. Proper patient selection, endoscopic hiatal hernia evaluation, and standardized suturing methods are necessary to ensure success of endoscopic suturing for antireflux therapy.
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He S, Xu F, Xiong X, Wang H, Cao L, Liang N, Wang H, Jing X, Liu T. Stretta procedure versus proton pump inhibitors for the treatment of nonerosive reflux disease: A 6-month follow-up. Medicine (Baltimore) 2020; 99:e18610. [PMID: 32011441 PMCID: PMC7220108 DOI: 10.1097/md.0000000000018610] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
To compare the Stretta procedure with proton pump inhibitors for the treatment of nonerosive reflux disease (NERD).From July 2018 to April 2019, patients diagnosed with NERD and referred for treatment were enrolled. They were treated with either Stretta procedure or proton pump inhibitor (PPI) medication and followed-up for 6 months. The symptom control, quality of life, lower esophageal sphincter (LES) pressure, 24-hour pH parameters, PPI usage and satisfaction rate were evaluated. The complications were assessed. The outcomes of the 2 groups were analyzed and compared.Twenty-eight patients in the Stretta group and 21 patients in the PPI group completed the 6-month follow-up. No severe adverse events occurred in both groups. Both interventions were effective in improvement of symptom and quality of life. The symptom score improvement was significantly superior in the Stretta group compared to the PPI group (6.3 ± 3.4 vs 8.5 ± 4.1, P = .03). LES pressure increased significantly in the Stretta group compared to the PPI group (14.2 ± 4.4 mm Hg vs 10.0 ± 4.0 mm Hg, P < .01). Although both interventions improved 24-hour pH parameters, including number of acid episodes (P = .27), acid exposure time (P = .39), and DeMeester score (P = .28), no difference was found between the 2 groups. Complete PPI cessation rate (82% vs 52%, P = .03) as well as satisfaction rate (89% vs 57%, P = .02) was much higher in Stretta group than those in the PPI groupThe Stretta procedure was safe and effective in the short term for the management of NERD. The Stretta procedure resulted in higher LES pressure and achieved better improvement of symptom control and PPI cessation than did PPI in the short term.
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Affiliation(s)
- Suyu He
- The Fourth Department of the Digestive Disease Center
| | - Fei Xu
- The Fourth Department of the Digestive Disease Center
| | - Xin Xiong
- The Fourth Department of the Digestive Disease Center
| | - Hui Wang
- The Fourth Department of the Digestive Disease Center
| | - Lipeng Cao
- The Fifth Department of the Digestive Disease Center
| | - Ninglin Liang
- The Fourth Department of the Digestive Disease Center
| | - Hanmei Wang
- The Fourth Department of the Digestive Disease Center
| | - Xiaojuan Jing
- The Endoscopy Center, Suining Central Hospital, Sichuan, China
| | - Tianyu Liu
- The Fourth Department of the Digestive Disease Center
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Hefler J, Dang J, Mocanu V, Switzer N, Birch DW, Karmali S. Concurrent bariatric surgery and paraesophageal hernia repair: an analysis of the Metabolic and Bariatric Surgery Association Quality Improvement Program (MBSAQIP) database. Surg Obes Relat Dis 2019; 15:1746-1754. [DOI: 10.1016/j.soard.2019.08.025] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Revised: 07/19/2019] [Accepted: 08/19/2019] [Indexed: 01/13/2023]
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14
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Hiatal hernias in patients with GERD-like symptoms: evaluation of dynamic real-time MRI vs endoscopy. Eur Radiol 2019; 29:6653-6661. [DOI: 10.1007/s00330-019-06284-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 04/17/2019] [Accepted: 05/24/2019] [Indexed: 12/11/2022]
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Nativ-Zeltzer N, Rameau A, Kuhn MA, Kaufman M, Belafsky PC. The Relationship Between Hiatal Hernia and Cricopharyngeus Muscle Dysfunction. Dysphagia 2018; 34:391-396. [DOI: 10.1007/s00455-018-9950-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2018] [Accepted: 10/06/2018] [Indexed: 01/11/2023]
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Lesiński J, Zielonka TM, Kaszyńska A, Wajtryt O, Peplińska K, Życińska K, Wardyn KA. Clinical Manifestations of Huge Diaphragmatic Hernias. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2018; 1039:55-65. [PMID: 28681184 DOI: 10.1007/5584_2017_49] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
Translocation of abdominal organs into the thoracic cavity may cause dyspnea, heart disorders, and gastric symptoms. Diaphragmatic hernias can cause diagnostic difficulties, since both clinical and radiological symptoms might imitate different disorders. In these cases computed tomography of the chest is the method of choice. The aim of this study was to assess clinical manifestations, risk factors, and prognosis in patients with huge diaphragmatic hernias with displacement of abdominal organs into the thorax, depending on the action taken. We carried out a retrospective study using data of patients hospitalized in the years 2012-2016. Ten patients were qualified for the study (8 women and 2 men). The mean age of the subjects was 86.5 ± 10.5 years. Thirty percent of the hernias were post-traumatic. All of the patients reported cardiovascular or respiratory symptoms. Upper gastrointestinal symptoms occurred in half of the patients. Twenty percent of patients underwent surgery with a positive outcome, while 30% of patients, who were not qualified for surgery due to numerous co-morbidities, died. The main risk factors predisposing to the occurrence of large diaphragmatic hernias were the following: old age, female gender, and thoracic cage deformities.
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Affiliation(s)
- Jan Lesiński
- Clinical Department of Internal Medicine, Czerniakowski Hospital in Warsaw, Warsaw, Poland
| | - Tadeusz M Zielonka
- Clinical Department of Internal Medicine, Czerniakowski Hospital in Warsaw, Warsaw, Poland.
- Department of Family Medicine, Warsaw Medical University, 1A Banacha Street, 02-097, Warsaw, Poland.
| | - Aleksandra Kaszyńska
- Clinical Department of Internal Medicine, Czerniakowski Hospital in Warsaw, Warsaw, Poland
| | - Olga Wajtryt
- Clinical Department of Internal Medicine, Czerniakowski Hospital in Warsaw, Warsaw, Poland
| | - Krystyna Peplińska
- Clinical Department of Internal Medicine, Czerniakowski Hospital in Warsaw, Warsaw, Poland
| | - Katarzyna Życińska
- Clinical Department of Internal Medicine, Czerniakowski Hospital in Warsaw, Warsaw, Poland
- Department of Family Medicine, Warsaw Medical University, 1A Banacha Street, 02-097, Warsaw, Poland
| | - Kazimierz A Wardyn
- Clinical Department of Internal Medicine, Czerniakowski Hospital in Warsaw, Warsaw, Poland
- Department of Family Medicine, Warsaw Medical University, 1A Banacha Street, 02-097, Warsaw, Poland
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Gorin SG, Khrupkin VI, Kustov AE, Andronov BA, Stradymov AA, Pisarevskaya AA, Verenok AM, Lyutov VD. [Perforated chronic gastric ulcer in sliding hiatus hernia]. Khirurgiia (Mosk) 2017:78-81. [PMID: 29286036 DOI: 10.17116/hirurgia20171278-81] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- S G Gorin
- War Veterans Hospital #2 of Moscow Healthcare Department
| | - V I Khrupkin
- War Veterans Hospital #2 of Moscow Healthcare Department; General Surgery Department of Sechenov First Moscow State Medical University, Moscow, Russia
| | - A E Kustov
- War Veterans Hospital #2 of Moscow Healthcare Department
| | - B A Andronov
- War Veterans Hospital #2 of Moscow Healthcare Department
| | - A A Stradymov
- War Veterans Hospital #2 of Moscow Healthcare Department
| | | | - A M Verenok
- War Veterans Hospital #2 of Moscow Healthcare Department
| | - V D Lyutov
- War Veterans Hospital #2 of Moscow Healthcare Department
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Influence of metabolic syndrome on upper gastrointestinal disease. Clin J Gastroenterol 2016; 9:191-202. [PMID: 27372302 DOI: 10.1007/s12328-016-0668-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Accepted: 06/19/2016] [Indexed: 12/22/2022]
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Kim C, Ouyang W, Dass C, Zhao H, Criner GJ. Hiatal Hernia on Chest High-Resolution Computed Tomography and Exacerbation Rates in COPD Individuals. CHRONIC OBSTRUCTIVE PULMONARY DISEASES-JOURNAL OF THE COPD FOUNDATION 2016; 3:570-579. [PMID: 28848881 DOI: 10.15326/jcopdf.3.2.2015.0158] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Background: Gastroesophageal reflux disease (GERD) is associated with frequent chronic obstructive pulmonary disease (COPD) exacerbations. Hiatal hernia (HH) contributes to GERD pathogenesis and is identifiable on chest high-resolution computed tomography (HRCT). We hypothesize that the presence of an HH on HRCT identifies those at increased risk for acute exacerbation of COPD. Methods: We retrospectively reviewed a prospectively enrolled cohort of smokers with and without airflow obstruction. HHs were identified visually on inspiratory HRCT. Individuals' demographic and clinical information was compared with secondary analysis performed using a propensity score generated matched cohort. Results: There were 523 COPD individuals and 607 unobstructed smokers. COPD individuals had more HHs than unobstructed smokers, (11.6% versus 6.1%, p < 0.001). COPD individuals with hernias were older, female, overweight and GERD positive as compared to those without hernia. There was no difference in self-reported exacerbation rates or hospitalizations per year, but similar severity of obstruction, smoking rates and long-term oxygen use. Analysis with the matched cohort revealed no significant difference in exacerbation rates. Conclusions: Presence of HHs on inspiratory HRCT scan did not predict worse symptoms or exacerbation rate in COPD individuals. Those with HHs were older, more obese, and predominantly female compared to those without HHs.
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Affiliation(s)
- Cynthia Kim
- Department of Pulmonary and Critical Care Medicine, Temple University Hospital, Philadelphia, Pennsylvania.,Co-first Authors
| | - Wei Ouyang
- Department of Radiology, Temple University Hospital, Philadelphia, Pennsylvania.,Co-first Authors
| | - Chandra Dass
- Department of Radiology, Temple University Hospital, Philadelphia, Pennsylvania
| | - Huaqing Zhao
- Temple Clinical Research Center, Temple University School of Medicine, Philadelphia, Pennsylvania
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Photographic Objective Alterations for Laryngopharyngeal Reflux Diagnosis. J Voice 2016; 31:78-85. [PMID: 26873421 DOI: 10.1016/j.jvoice.2015.12.021] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Accepted: 12/30/2015] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Diagnosis of laryngopharyngeal reflux (LPR) in clinical practice is generally made subjectively based on history, symptoms, and endoscopic assessment. This study presents the diagnostic role of the digital photographic assessment of the laryngopharyngeal region for LPR. METHODS Seventy-two patients with LPR symptoms and 35 healthy volunteers were evaluated using the Reflux Finding Scores (RFS) and the Reflux Symptom Index (RSI). The results of these scales were recorded in 72 patients representing group 1 with LPR diagnosis; they returned after 1 and 2 months of treatment as groups 2 and 3, respectively. Thirty-five volunteers represented group 4. Laryngopharyngeal regions of all subjects were examined and photographed endoscopically. Red, green, and blue (RGB) values of particular oropharyngeal and laryngeal points were measured. RESULTS RSI and RFS values of group 1 were significantly different from the other three groups, as were the scores of group 2; however, the comparison of the RSI and RFS values of groups 3 and 4 did not reveal a statistically significant difference. Laryngopharyngeal RGB values also duplicated statistical significance as above. CONCLUSION Measurement of RGB values can be a cheap and easy-to-use method to quickly provide objective and corroborative information to help in the diagnosis of LPR in conjunction with subjective methods.
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Abstract
OBJECTIVES Hiatal hernia (HH) affects from 10% to 50% of adult population. The correlation between HH, gastroesophageal reflux disease, dyspeptic symptoms, and esophagitis has long been known in adults. The primary objective of our prospective observational study was to estimate the prevalence of HH in children undergoing esophagogastroduodenoscopy (EGD), irrespective of their symptoms. METHODS We prospectively enrolled 111 consecutive children (48 boys and 63 girls; mean age 94.9 ± 52.3 months) referred for EGD. In all of the patients a symptomatic score assessment based on the Rome III criteria was used to measure frequency, severity, and duration of gastrointestinal symptoms. HH presence was endoscopically defined; esophagitis presence was evaluated either endoscopically and histologically. Children were divided in 2 age-range groups: <48 months (group 1) and >48 months (group 2). RESULTS Twenty-three patients of 111 (20.7%) had evidence of a sliding HH at EGD. In children from group 2, we found a statistically significant association of HH with heartburn (P = 0.03, 95% confidence interval 1-9.3, r = 0.1) and regurgitation (P = 0.003, 95% confidence interval 1.7-20.4, r = 0.3). Regarding esophagitis presence, no association was found at any age either with defined esophagitis or with dilated intercellular spaces. CONCLUSIONS Prevalence of HH in our study population was 20.7%. According to our data, HH correlates with the presence of heartburn and regurgitation in children, but not in toddlers. No association was found with esophagitis at any age.
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Lindow TA, Franzen T. Evaluation of the Splash Time Test as a Bedside Test for Hiatal Hernia. Gastroenterology Res 2014; 7:118-122. [PMID: 27785281 PMCID: PMC5040534 DOI: 10.14740/gr629w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/11/2014] [Indexed: 11/12/2022] Open
Abstract
Background Hiatal hernias may present with heartburn, acid regurgitation, dysphagia, chest pain, pulmonary symptoms and globus jugularis. Due to the heterogeneous presentation, there is a need for a simple diagnostic instrument when hiatal hernia is suspected. Hiatal hernia may impair esophageal bolus transportation. The splash time test is a rough measurement of esophageal bolus transportation, where time is measured from the start of swallowing a liquid bolus to the appearance of a “splashing” sound at xiphoid level. We aimed to test the hypothesis that the splash time test is prolonged in patients with hiatal hernia compared to normal subjects. Methods In 30 patients with hiatal hernia, time was measured from swallow to splash using audiosignal recording. Thirty healthy subjects were used as controls. Results Median time from swallow to splash was 4.9 seconds in the patient group and 4.4 seconds in the control group. Five patients, but none of the controls, performed swallows with absence of splash. Using only absence of splash as a pathological result, sensitivity was 23% and specificity was 100%. Conclusion The splash time test is not a sensitive instrument in diagnosing hiatal hernias. The absence of splash, however, seems to be a specific marker of hiatal hernia. Further research is needed regarding which other conditions besides hiatal hernia may cause absence of splash. The splash time test can be replaced by the even simpler “splash test”.
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Affiliation(s)
- Thomas Akesson Lindow
- Department of Clinical Physiology, Blekingesjukhuset Karlskrona, Karlskrona, Sweden; Department of Clinical Physiology, Centralsjukhuset Vaxjo, Vaxjo, Sweden
| | - Thomas Franzen
- Department of Surgery and Department of Clinical and Experimental Medicine, Linkoping University, Norrkoping, Sweden
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Che F, Nguyen B, Cohen A, Nguyen NT. Prevalence of hiatal hernia in the morbidly obese. Surg Obes Relat Dis 2013; 9:920-4. [PMID: 23810611 DOI: 10.1016/j.soard.2013.03.013] [Citation(s) in RCA: 107] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2012] [Revised: 03/03/2013] [Accepted: 03/03/2013] [Indexed: 01/28/2023]
Abstract
BACKGROUND Morbidly obese patients commonly have gastroesophageal reflux (GERD) and associated hiatal hernias. As such, some surgeons routinely perform a concomitant hiatal hernia repair during bariatric surgery. However, the intraoperative inspection for a hiatal hernia based on laparoscopic visualization can be misleading. The aim of this study was to assess the prevalence of hiatal hernias in morbidly obese patients based on preoperative upper gastrointestinal (GI) contrast study. METHODS Data on 181 patients who underwent routine upper GI contrast study as part of a preoperative workup for bariatric surgery were reviewed. The upper GI studies were examined for the presence of hiatal hernias and GERD. Hiatal hernias were categorized by size as small (≤2 cm), moderate (2-5 cm), or large (>5 cm). GERD was based on radiologic evidence and categorized as mild, moderate, or severe. RESULTS The mean age of the cohort was 44 years, with a mean body mass index of 43 kg/m(2). Of the 181 patients overall, based on the upper GI contrast study, the prevalence of hiatal hernia was 37.0% and of GERD was 39.8%; the prevalence of moderate or large hiatal hernia was 4.4%, and the prevalence of moderate or severe GERD was 13.3%. CONCLUSIONS Based on upper GI contrast study, we identified the presence of a hiatal hernia in nearly 40% of morbidly obese patients. The results from this study suggest that surgeons should evaluate the morbidly obese patient for the presence of hiatal hernias and perform concomitant repair at the time of the bariatric procedure, particularly in patients undergoing gastric banding and sleeve gastrectomy, while less so in the gastric bypass patient.
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Affiliation(s)
- Fredrick Che
- Department of Surgery, University of California, Irvine Medical Center, Orange, California
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24
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Park CH, Kim KO, Baek IH, Choi MH, Jang HJ, Kae SH, Kim JB, Baik GH, Shin WG, Kim KH, Kim HY. Differences in the risk factors of reflux esophagitis according to age in Korea. Dis Esophagus 2012; 27:116-21. [PMID: 23009198 DOI: 10.1111/j.1442-2050.2012.01417.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The prevalence of gastroesophageal reflux disease in Korea has been believed to be low, but the incidence of gastroesophageal reflux disease in Korea is expected to increase because of the longer life expectancy and more ingestion of westernized food. The aim of this study was to report differences in the risk factors of reflux esophagitis (RE) according to age in Korea. We prospectively recruited the subjects who had RE among those who visited a health promotion center for upper gastrointestinal cancer surveillance at Hallym Medical Center (five institutions) between January 2008 and February 2009. The enrolled study participants comprised 742 subjects with RE and 1484 healthy controls. The independent risk factors of RE in young and adult group were male sex, smoking, coffee, body mass index ≥ 25, hiatal hernia, and Helicobacter pylori negativity. The risk factors of RE in elderly group were smoking, coffee, and hiatal hernia. The risk factors for RE according to age group were found to differ. In elderly group, Helicobacter pylori infection was not a significant protective factor contrary to young and adult groups.
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Affiliation(s)
- C H Park
- Department of Gastroenterology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
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Is there a role for dynamic swallowing MRI in the assessment of gastroesophageal reflux disease and oesophageal motility disorders? Eur Radiol 2011; 22:364-70. [PMID: 21894565 DOI: 10.1007/s00330-011-2258-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2011] [Accepted: 08/23/2011] [Indexed: 12/14/2022]
Abstract
OBJECTIVES To evaluate the diagnostic value of dynamic MRI swallowing in patients with symptoms of Gastroesophageal Reflux Disease (GERD). METHODS Thirty-seven patients (17 m/20f) with typical signs of GERD underwent MR swallowing in the supine position at 1.5 T with a phased-array body coil. Using dynamic, gradient echo sequences (B-FFE) in the coronal, sagittal and axial planes, the bolus passages of buttermilk spiked with gadolinium chelate were tracked. MRI, pH-metry and manometry were performed within 31 days and results were compared. RESULTS MRI results were concordant with pH-metry in 82% (23/28) of patients diagnosed with abnormal oesophageal acid exposure by pH-metry. Five patients demonstrated typical symptoms of GERD and had positive findings with pH monitoring, but false negative results with MRI. In four of six patients (67%), there was a correct diagnosis of oesophageal motility disorder, according to manometric criteria, on dynamic MRI. The overall accuracy of MRI diagnoses was 79% (27/34). A statistically significant difference was found between the size of hiatal hernia, grade of reflux in MRI, and abnormal acid exposure on pH-monitoring. CONCLUSIONS MR fluoroscopy may be a promising radiation-free tool in assessing the functionality and morphology of the GE junction. KEY POINTS • Swallowing MRI can assess anatomy and function of the gastroesophageal-junction • Swallowing MRI can help identifying reflux and motility disorders • Definition of the size of hiatal hernias is possible in all three planes in MR. • Short duration of swallowing MRI enables its application in routine clinical practice.
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Abstract
The relationship between hiatal hernias and gastroesophageal reflux disease (GERD) has been greatly debated over the past decades, with the importance of hiatal hernias first being overemphasized and then later being nearly neglected. It is now understood that both the anatomical (hiatal hernia) and the physiological (lower esophageal sphincter) features of the gastroesophageal junction play important, but independent, roles in the pathogenesis of GERD, constituting the widely accepted "two-sphincter hypothesis." The gastroesophageal junction is an anatomically complex area with an inherent antireflux barrier function. However, the gastroesophageal junction becomes incompetent and esophageal acid clearance is compromised in patients with hiatal hernia, which facilitates the development of GERD. Of the different types of hiatal hernias (types I, II, III, and IV), type I (sliding) hiatal hernias are closely associated with GERD. Because GERD may lead to reflux esophagitis, Barrett's esophagus and esophageal adenocarcinoma, a better understanding of this association is warranted. Hiatal hernias can be diagnosed radiographically, endoscopically or manometrically, with each modality having its own limitations, especially in the diagnosis of hiatal hernias less than 2 cm in length. In the future, high resolution manometry should be a promising method for accurately assessing the association between hiatal hernias and GERD. The treatment of a hiatal hernia is similar to the management of GERD and should be reserved for those with symptoms attributable to this condition. Surgery should be considered for those patients with refractory symptoms and for those who develop complications, such as recurrent bleeding, ulcerations or strictures.
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Affiliation(s)
- Jong Jin Hyun
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
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27
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Abstract
The relationship between hiatal hernias and gastroesophageal reflux disease (GERD) has been greatly debated over the past decades, with the importance of hiatal hernias first being overemphasized and then later being nearly neglected. It is now understood that both the anatomical (hiatal hernia) and the physiological (lower esophageal sphincter) features of the gastroesophageal junction play important, but independent, roles in the pathogenesis of GERD, constituting the widely accepted "two-sphincter hypothesis." The gastroesophageal junction is an anatomically complex area with an inherent antireflux barrier function. However, the gastroesophageal junction becomes incompetent and esophageal acid clearance is compromised in patients with hiatal hernia, which facilitates the development of GERD. Of the different types of hiatal hernias (types I, II, III, and IV), type I (sliding) hiatal hernias are closely associated with GERD. Because GERD may lead to reflux esophagitis, Barrett's esophagus and esophageal adenocarcinoma, a better understanding of this association is warranted. Hiatal hernias can be diagnosed radiographically, endoscopically or manometrically, with each modality having its own limitations, especially in the diagnosis of hiatal hernias less than 2 cm in length. In the future, high resolution manometry should be a promising method for accurately assessing the association between hiatal hernias and GERD. The treatment of a hiatal hernia is similar to the management of GERD and should be reserved for those with symptoms attributable to this condition. Surgery should be considered for those patients with refractory symptoms and for those who develop complications, such as recurrent bleeding, ulcerations or strictures.
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Affiliation(s)
- Jong Jin Hyun
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
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28
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Should Small Sliding Hiatal Hernias Be Reported at CT Colonography? AJR Am J Roentgenol 2011; 196:W400-4. [DOI: 10.2214/ajr.10.5392] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Brown SR, Melman L, Jenkins E, Deeken C, Frisella MM, Brunt LM, Eagon JC, Matthews BD. Collagen type I:III ratio of the gastroesophageal junction in patients with paraesophageal hernias. Surg Endosc 2010; 25:1390-4. [PMID: 21046161 DOI: 10.1007/s00464-010-1373-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2010] [Accepted: 09/12/2010] [Indexed: 11/29/2022]
Abstract
BACKGROUND The purpose of this study was to examine the biological environment of the esophageal hiatus through analysis of the collagen content within the gastrohepatic ligament (GHL), gastrophrenic ligament (GPL), and phrenoesophageal ligament (PEL) in patients with type I hiatal hernias (HH) and type III paraesophageal hernias (PEH). METHODS A control group (N=10) and patients with type I HH (N=10) and type III PEH (N=10) were included in the analysis. Specimens of the GHL, PEL, and GPL were collected intraoperatively. Slides stained with sirius red/fast green were created and ten photos at 400×magnification were taken of each specimen. Axiovision 4.7 (Zeiss) photo analysis software was employed for quantification of collagen I (red) and III (green) by calculating color area (μm2). Statistical significance (p<0.05) was determined using a one-way ANOVA and Fisher's LSD post-test. RESULTS Cross-polarization microscopy revealed that the collagen I content was similar in the three study groups for the GHL, greater in the type III PEH group and in the control group compared to the type I HH group for the PEL, and greater in the type III PEH group compared to control group for the GPL. Collagen III quantity was greater in the control group than in the type I HH group for each ligament, and greater in the GHL and PEL when compared to the type III PEH group. Type III PEH patients had greater collagen III quantity than did type I HH patients for each ligament. Collagen type I:III ratio of the GHL was greater in both hernia groups compared to the control group. Type III PEH patients contained a higher I:III ratio than both the control and type I HH groups with respect to the PEL. There was no difference in the ratio with evaluation of the GPL for the three groups. CONCLUSION Evaluation of the esophageal hiatus revealed that patients with PEH have a different biological environment with regard to collagen content compared to control patients. The collagen I:III ratio of the study groups was equal to or greater than the control group. Collagen deficiency in the GE junction supporting ligaments does not appear to be an etiology of PEH formation.
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Affiliation(s)
- Shaun R Brown
- Section of Minimally Invasive Surgery, Department of Surgery, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box #8109, St. Louis, MO 63110, USA
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Chiba N, Fennerty MB. Gastroesophageal Reflux Disease. EVIDENCE‐BASED GASTROENTEROLOGY AND HEPATOLOGY 2010:17-61. [DOI: 10.1002/9781444314403.ch2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2025]
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Scheffer RCH, Bredenoord AJ, Hebbard GS, Smout AJPM, Samsom M. Effect of proximal gastric volume on hiatal hernia. Neurogastroenterol Motil 2010; 22:552-6, e120. [PMID: 20105278 DOI: 10.1111/j.1365-2982.2009.01460.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Spatial separation of the diaphragm and the lower esophageal sphincter (LES) occurs frequently and intermittently in patients with a sliding hiatus hernia and favors gastro-esophageal reflux. This can be studied with high-resolution manometry. Although fundic accommodation is associated with a lower basal LES pressure, its effect on esophagogastric junction configuration and hiatal hernia is unknown. Therefore, the aim of this study was to investigate the relationship between proximal gastric volume, the presence of a hiatal hernia profile and acid reflux. METHODS Twenty gastro-esophageal reflux disease (GERD) patients were studied and compared to 20 healthy controls. High-resolution manometry and pH recording were performed for 1 h before and 2 h following meal ingestion (500 mL per 300 kcal). Volume of the proximal stomach was assessed with three-dimensional ultrasonography before and every 15 min after meal ingestion. KEY RESULTS During fasting, the hernia profile [2 separate high-pressure zones (HPZs) at manometry] was present for 31.9 +/- 4.9 min h(-1) (53.2%) in GERD patients, and 8.7 +/- 3.3 min h(-1) (14.5%) in controls (P < 0.001). In GERD patients, the presence of hernia profile decreased during the first postprandial hour to 15.9 +/- 4.2 min h(-1), 26.5%, P < 0.01 whilst this phenomenon was not observed in controls. The rate of transition between the two profiles was 5.7 +/- 1.1 per hour in GERD patients and 2.5 +/- 1.0 per hour in controls (P < 0.001). The pre and postprandial acid reflux rate in GERD patients during the hernia profile (6.4 +/- 1.1 per hour and 18.4 +/- 4.3 per hour respectively) was significantly higher than during reduced hernia (2.1 +/- 0.6 per hour; P < 0.05 and 3.8 +/- 0.9 per hour; P < 0.05). A similar difference was found in controls. Furthermore, an inverse correlation was found between fundic volume and the time the hernia profile was present (r = -0.45; P < 0.05) in GERD patients, but not in controls. CONCLUSIONS & INFERENCES (i) In GERD patients a postprandial increase in proximal gastric volume is accompanied by a decrease in hernia prevalence, which can be explained by a reduction of the intra-thoracic part of the stomach. (ii) A temporal hernia profile also occurs in healthy subjects. (iii) During the hernia profile, acid reflux is more prevalent, especially after meal ingestion.
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Affiliation(s)
- R C H Scheffer
- Department of Gastroenterology and Hepatology, University Medical Center, Utrecht, The Netherlands.
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Hyun JJ, Kim JH, Yeon JE, Park JJ, Kim JS, Byun KS, Bak YT. Short segment hiatal hernia: is it a clinically significant entity? J Neurogastroenterol Motil 2010; 16:35-9. [PMID: 20535324 PMCID: PMC2879821 DOI: 10.5056/jnm.2010.16.1.35] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2009] [Accepted: 11/26/2009] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION Hiatal hernia (HH) is a well-known contributory factor of gastroesophageal reflux disease (GERD). However, studies on the clinical significance of simple small HH are lacking. We conducted a study to clarify the clinical significance of short segment HH (SSHH) in relation to GERD. METHODS 4,592 consecutive cases (male/female: 2,076/2,516, median age: 49 years) examined with diagnostic esophagogastroduodenoscopy for the first time were enrolled. During the insertion of endoscope, presence of HH was determined and the length was measured, if present. The relationships between gender, age, presence of erosive esophagitis, and columnar-lined esophagus (CLE) and the lengths of HH were analyzed. RESULTS Among 4,592 cases, HH was present in 428 cases (9.3%); SSHH was found in 255 cases (5.6%) and long segment HH (LSHH) in 173 cases (3.8%). HH was more frequent among males and patients with LSHH tended to be older. Erosive esophagitis was observed in 4.8%, 22.0%, and 37.0% of no HH, SSHH, and LSHH group, respectively (p <0.05). CLE was observed in 14.4%, 36.5%, and 24.3% of no HH, SSHH, and LSHH group, respectively (p <0.05). CONCLUSIONS SSHH is not a clinically silent and "innocent entity," but rather a condition with a significant pathologic significance similar to LSHH in regard to GERD.
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Affiliation(s)
- Jong Jin Hyun
- Department of Gastroenterology, Korea University Guro Hospital, Seoul, Korea
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Iwakiri K. The role of excessive esophageal acid exposure in patients with gastroesophageal reflux disease. Clin J Gastroenterol 2009; 2:371-379. [PMID: 26192789 DOI: 10.1007/s12328-009-0125-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2009] [Accepted: 10/21/2009] [Indexed: 01/10/2023]
Abstract
Gastroesophageal reflux disease (GERD), especially reflux esophagitis (RE), is characterized by excessive esophageal acid exposure. Transient lower esophageal sphincter (LES) relaxation is the major mechanism of acid reflux episodes in both healthy subjects (HS) and patients with GERD. In the sitting position, where acid reflux episodes often occur, there is no difference in the frequency of transient LES relaxations between these two groups; however, in patients with GERD, at 5 cm above the LES, the proportion of acid reflux episodes during transient LES relaxations is significantly greater than in the HS group. This difference is considered to be one of the causes of excessive esophageal acid exposure in patients with GERD, but its cause is still unclear. A recent study, which investigated the proportion of acid reflux episodes during transient LES relaxations at 2 and 7 cm above the LES, showed that there was no difference at 2 cm above the LES between HS and patients with RE, but at 7 cm they were significantly greater in patients with RE than in HS. Evaluation of acid reflux at 2 cm above the LES is difficult to measure, but the proximal extent of refluxate could be one of the important factors of excessive acid esophageal exposure in patients with RE. Ineffective esophageal motility, found in patients with moderate to severe RE, impairs esophageal bolus clearance of acid, therefore both the proximal extent of refluxate and the delay of esophageal bolus clearance of acid could be major causes of excessive esophageal acid exposure. Hiatus hernia also causes acid reflux, due to its association with hypotensive LES, and also impairs esophageal bolus clearance of acid.
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Affiliation(s)
- Katsuhiko Iwakiri
- Division of Gastroenterology, Department of Medicine, Nippon Medical School, Sendagi 1-1-5, Bunkyo-ku, Tokyo, 113-8603, Japan.
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Increasing prevalence of erosive esophagitis among Taiwanese aged 40 years and above: a comparison between two time periods. J Clin Gastroenterol 2009; 43:926-32. [PMID: 19384245 DOI: 10.1097/mcg.0b013e318191e9d5] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Earlier prevalence studies have reported an increasing trend of gastroesophageal reflux disease in Asia, and obesity may be the promoting factor. GOALS This study compared the prevalence of erosive esophagitis and obesity status among the same source of subjects in Taiwan between 1995 and 2002. STUDY In the same routine health checkup unit, we recruited 1902 apparently healthy adults in 2002 matched by sex and age with 2044 individuals recruited in 1995. The prevalence of esophagitis and body mass index between these 2 groups were compared. RESULTS The crude prevalence of esophagitis increased from 5% in 1995 to 12.6% in 2002 (P<0.0001). Comparing by age stratum, there was an increase of esophagitis among subjects aged 40 years and above, with a dose-response relationship of adjusted prevalence ratios 2.65 [95% confidence interval (CI): 1.10, 4.20] in those aged 40 to 49 years, 3.15 (95% CI: 1.51, 4.79) in those aged 50 to 59 years, and 4.33 (95% CI: 2.56, 6.11) in those aged 60 years and above. The prevalence of esophagitis increased in both sexes. BMI was positively associated with the presence of esophagitis in women, but the proportion of overweight or obesity did not increase in women aged 40 years and above over time. CONCLUSIONS There was a 2.5-fold of increase in prevalence of erosive esophagitis among Taiwanese adults from 1995 to 2002, particularly in those aged 40 years and above. Factors other than obesity seem to contribute to the increasing trend of erosive esophagitis in Taiwanese women.
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Does the presence of a hiatal hernia affect the efficacy of the reflux inhibitor baclofen during add-on therapy? Am J Gastroenterol 2009; 104:1764-71. [PMID: 19491837 DOI: 10.1038/ajg.2009.247] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Reflux inhibitors, like the gamma-aminobutyric acid type B (GABA(B)) receptor agonist, baclofen, block transient lower esophageal sphincter relaxations (TLESRs) and are proposed as an add-on therapy in patients with proton pump inhibitor (PPI)-resistant gastroesophageal reflux. However, as other mechanisms of reflux become more important in the presence of a hiatal hernia (HH), the efficacy of reflux inhibitors to reduce acid and non-acid exposure may be hampered. Therefore, we compared the effect of baclofen in patients with no HH (-HH) and those with a large HH during PPI treatment. METHODS A total of 27 gastroesophageal reflux disease (GERD) patients on PPI were included; 16 had -HH and 11 had a large (> or =3 cm) HH (+HH). During PPI treatment, the effect of baclofen (3 x 20 mg) on acid and non-acid reflux was evaluated in a randomized, double-blind, placebo-controlled cross-over study. Reflux was measured during 24 h using combined esophageal impedance and pH-metry. RESULTS The majority of reflux events consisted of both gaseous and liquid reflux with a significant increase in non-acid, mixed reflux episodes in +HH patients compared with those in -HH patients. Acid exposure time was in the normal range in both patient groups during both placebo and baclofen. In this study, baclofen significantly reduced the total number of reflux episodes with 36% in -HH patients and 43% in +HH patients, but did not change the number of acid reflux episodes or total acid exposure time. CONCLUSIONS This study shows that baclofen is also effective in patients with GERD with +HH, further underscoring the potential of reflux inhibitors as treatment of GERD.
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Sihvo EI, Salo JA, Räsänen JV, Rantanen TK. Fatal complications of adult paraesophageal hernia: A population-based study. J Thorac Cardiovasc Surg 2009; 137:419-24. [DOI: 10.1016/j.jtcvs.2008.05.042] [Citation(s) in RCA: 95] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2008] [Revised: 04/18/2008] [Accepted: 05/18/2008] [Indexed: 01/11/2023]
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Ko HH. Pathophysiology of GERD*. Can Pharm J (Ott) 2008. [DOI: 10.3821/1913-701x(2008)141[s9:pog]2.0.co;2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Reflux oesophagitis in Italy (Diomede project). Dig Liver Dis 2008; 40:405-11. [PMID: 18294931 DOI: 10.1016/j.dld.2007.12.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2007] [Revised: 11/13/2007] [Accepted: 12/17/2007] [Indexed: 12/11/2022]
Abstract
AIMS A multicentric observational study was performed to update the available information on reflux oesophagitis in Italy. METHODS In phase I, the number and severity of reflux oesophagitis diagnosed in 1 year (2003) were reported together with the associated endoscopic findings. In phase II, oesophagitis patients consecutively referred in a 3-month period were analysed. A multivariate analysis was used to identify the risk factors for severe oesophagitis. RESULTS 253,992 upper endoscopies were collected. The overall prevalence of oesophagitis was 14.8% and the endoscopic findings associated with oesophagitis were hiatus hernia (46.3%), duodenal ulcer (10.7%), gastric ulcer (3.6%) and Barrett's oesophagus (2.9%). In phase II, 1542 reflux oesophagitis patients were analysed (60.3% males; mean age 50.7 +/-16.6 years). Only 53.4% of patients reported heartburn and/or regurgitation as main complaint. Severe symptoms, age > 50 years, hiatus hernia and male gender were identified as independent predictors of severe oesophagitis. CONCLUSIONS Oesophagitis is the most frequent among the peptic diseases of the upper gastro-intestinal tract. Only half of the oesophagitis patients reported typical reflux symptoms as dominant. Advanced age, male gender, severe symptoms and hiatus hernia were independent risk factors for severe disease.
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Ariizumi K, Koike T, Ohara S, Inomata Y, Abe Y, Iijima K, Imatani A, Oka Y, Shimosegawa T. Incidence of reflux esophagitis and Helicobacter pylori infection in diabetic patients. World J Gastroenterol 2008; 14:3212-7. [PMID: 18506928 PMCID: PMC2712855 DOI: 10.3748/wjg.14.3212] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the incidence of reflux esophagitis (RE) and H pylori infection in the diabetic patient.
METHODS: The incidence of RE and H pylori infection were investigated in 85 patients with diabetes mellitus and the results were compared with controls.
RESULTS: The incidence of RE in diabetic patients was 17.6%. Although this tended to be higher in diabetic patients, there were no statistically significant differences between diabetic patients and controls. The incidence of H pylori infection in diabetic patients was 53.7% but no statistically significant difference was seen between diabetic patients and controls in the incidence of H pylori infection.
CONCLUSION: No significant differences could be seen between diabetic patients and controls in the incidence of RE and H pylori infection.
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Esophagus Benign Diseases of the Esophagus. Surgery 2008. [DOI: 10.1007/978-0-387-68113-9_44] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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El Sherif A, Yano F, Mittal S, Filipi CJ. Collagen metabolism and recurrent hiatal hernia: cause and effect? Hernia 2007; 10:511-20. [PMID: 17021673 DOI: 10.1007/s10029-006-0152-9] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Hiatus hernia (HH) is a condition characterized by herniation of the intra-abdominal organs into the thorax. Of the several types that have been identified, the most common is type I (sliding) HH. Congenital predisposition and acquired factors, for example trauma and iatrogeny, have been identified as causative factors. There is a strong association between gastroesophageal reflux disease and HH-the prevalence of reflux in HH may reach 94%. Many methods have been used to treat reflux disease and HH, among which are laparoscopic techniques, which gained popularity as a safe method of treatment. Primary crural repair without mesh application was found to have a recurrence rate of up to 42%. This led to the introduction of mesh in HH repair, which was associated with a significant decrease in recurrence rate. Collagen and its relation to hernia have been investigated for several decades. Collagen has mechanical properties sufficient to enable it to support healed scars and other tissues. Nineteen distinct types of collagen have been recognized, the most common of which are types I and III. Type III collagen is the major constituent of early granulation tissue whereas type I predominates as healing proceeds. Collagen fibers are imbedded in extracellular matrix (ECM), which is in continuous process of synthesis and degradation under the action of matrix metalloproteinases. Many authors have studied the role of collagen in ventral hernia and have even defined hernia as a disease of the ECM. The relationship between collagen and HH, and its recurrence, is not fully understood and needs further investigation.
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Affiliation(s)
- Amr El Sherif
- Department of surgery, Suite 3740, Creighton University School of Medicine, 601 N 30th Street, Omaha, NE 68131-2197, USA
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Sgouros SN, Mpakos D, Rodias M, Vassiliades K, Karakoidas C, Andrikopoulos E, Stefanidis G, Mantides A. Prevalence and axial length of hiatus hernia in patients, with nonerosive reflux disease: a prospective study. J Clin Gastroenterol 2007; 41:814-8. [PMID: 17881926 DOI: 10.1097/01.mcg.0000225678.99346.65] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND AND AIMS The relationship between hiatus hernia and reflux esophagitis is well established. However, there are conflicting reports regarding its effect on the development of nonerosive reflux disease (NERD). Our aim was to investigate the prevalence and axial length of hiatus hernia in patients with NERD, compared with patients with reflux esophagitis, Barrett esophagus, and controls. METHODS Axial hernia length of the diaphragmatic hiatus was measured prospectively at endoscopy in controls and patients with typical reflux symptoms occurring at least weekly during the last month relieved by antacids. RESULTS A final diagnosis of hiatus hernia was established in 21.2% of 249 controls, 60.4% of 346 patients with NERD, 78.1% of 251 patients with reflux esophagitis, and 88.2% of 17 patients with Barrett esophagus. Patients aged >59 years were most likely to have a hiatus hernia. There was an increased prevalence in patients with NERD as compared with controls (P<0.0001), and decreased prevalence as compared with those with reflux esophagitis and Barrett esophagus (P<0.0001 and 0.02, respectively). Axial length of hiatus hernia >3 cm was found more frequently in patients with reflux esophagitis and Barrett esophagus as compared with patients with NERD (P<0.0001 and 0.0052, respectively). There was no statistical significant difference between controls and patients with NERD regarding the prevalence of hiatus hernia >3 cm (P=0.0904). CONCLUSIONS A small (<3 cm) hiatus hernia may contribute to the development of NERD, whereas an axial length >3 cm is associated with a more severe disease.
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Affiliation(s)
- Spiros N Sgouros
- Department of Gastroenterology, Athens Naval Hospital, Athens, Greece.
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Nouraie M, Radmard AR, Zaer-Rezaii H, Razjouyan H, Nasseri-Moghaddam S, Malekzadeh R. Hygiene could affect GERD prevalence independently: a population-based study in Tehran. Am J Gastroenterol 2007; 102:1353-60. [PMID: 17437507 DOI: 10.1111/j.1572-0241.2007.01208.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Population-based data on gastroesophageal reflux disease (GERD) in Iran are limited. Current study is going to determine the prevalence of GERD in Tehran, Iran, and its association with potential risk factors. METHODS In this cross-sectional study, a random clustered sample of Tehran province permanent households was selected from the latest postcodes. Data were collected by direct interview for each person aged 18-65 yr. GERD was defined as the existence of at least weekly episodes of heartburn and/or acid regurgitation during the last 6 months. All participants were asked about past and recent sanitary conditions, oral hygiene, and smoking. Odds ratios and 95% confidence intervals (CI) were calculated using multivariable analysis. RESULTS Interview was performed with 2,561 eligible subjects (42.3% men). Response rate was 84.8%. The prevalence of GERD was 21.2% (95% CI 18.7-23.7). According to multivariable logistic regression analyses, individuals whose drinking water was obtained from well or tank during childhood were more prone to experience GERD symptoms (OR 1.54, 95% CI 1.03-1.77 and OR 2.46, 95% CI 1.53-3.96, respectively). We also detected significant associations with increasing number of missing teeth (P value for linear trend = 0.02) and history of unpurified water consumption during past 10 yr (P < 0.001). Current smokers had a higher prevalence of reflux (OR 1.82, 95% CI 1.32-2.51). CONCLUSION The prevalence of GERD in our Iranian population was considerably higher than that reported from other Asian studies approaching western figures. GERD prevalence was significantly associated with the history of unpurified water consumption, poor sanitary conditions of childhood, number of missing teeth, and smoking in this population.
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Affiliation(s)
- Mehdi Nouraie
- Digestive Disease Research Center, Shariati Hospital, Medical Sciences/University of Tehran, Tehran, Iran
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Linke GR, Borovicka J, Schneider P, Zerz A, Warschkow R, Lange J, Müller-Stich BP. Is a barium swallow complementary to endoscopy essential in the preoperative assessment of laparoscopic antireflux and hiatal hernia surgery? Surg Endosc 2007; 22:96-100. [PMID: 17522930 DOI: 10.1007/s00464-007-9379-5] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2007] [Revised: 02/08/2007] [Accepted: 02/28/2007] [Indexed: 12/15/2022]
Abstract
BACKGROUND Barium swallow is considered essential in the preoperative assessment of gastroesophaeal reflux disease and hiatal hernias. The objective of this study was to investigate the effective value of a barium swallow if complementary to the commonly recommended endoscopy before laparoscopic antireflux and hiatal hernia surgery. METHODS We prospectively evaluated 40 consecutive patients who were tested with preoperative barium swallow and endoscopy before laparoscopic surgery for gastroesophageal reflux disease and/or symptomatic hiatal hernia. Results regarding the presence and the type of hiatal hernia found by barium swallow and endoscopy were correlated with the intraoperative finding as the reference standard. RESULTS Intraoperative findings revealed 21 axial, 7 paraesophageal, and 12 mixed hiatal hernias. Barium swallow and endoscopy allowed the diagnosis of hiatal hernia in 75% and 97.5%, respectively (p = 0.003). The correct classification of hiatal hernia was confirmed in 50% by barium swallow and 80% by endoscopy (p = 0.005). CONCLUSIONS Although barium swallow is recommended as an important diagnostic tool in the workup before surgical antireflux and hiatal hernia therapy, our results suggest that if mandatory endoscopy is performed preoperatively, a barium swallow does not provide any further essential information. It seems that barium swallow can be omitted as a basic diagnostic test before primary laparoscopic antireflux and hiatal hernia surgery.
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Affiliation(s)
- Georg R Linke
- Department of Surgery, Kantonsspital St. Gallen, 9007 St., Gallen, Switzerland
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Silva LFD, de Oliveira Lemme EM. Are there any differences between nutcracker esophagus with and without reflux? Dysphagia 2007; 22:245-50. [PMID: 17457546 DOI: 10.1007/s00455-007-9081-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2006] [Accepted: 01/29/2007] [Indexed: 11/25/2022]
Abstract
"Nutcracker esophagus" (NE) is a primary esophageal motor disorder, first described in patients with noncardiac chest pain. In recent years NE has been associated with gastroesophageal reflux disease (GERD). In this study we compare patients with NE with and without GERD, as defined by pHmetry or endoscopy, with respect to clinical, endoscopic, radiologic, and manometric findings. Fifty-two patients with NE were studied. They were divided in two groups: GERD (17-32.6%) and non-GERD (35-67.4%) patients. Females predominated in both groups, with no significant difference in age (p>0.05). Chest pain was the chief complaint in both groups (p>0.05). Clinical findings in patients with and without reflux included chest pain (52.9% and 51.4%), dysphagia (58.8% and 42.8%), and heartburn (64.7% and 42.8%), followed by regurgitation, dyspepsia, ear, nose, and throat (ENT) complaints, respiratory symptoms, and odynophagia (p>0.05). Erosive esophagitis was found in three patients (5.7%). There were no differences between groups in the findings of barium swallow studies and all manometric findings were similar for both groups (p>0.05). We conclude that there were no differences in patients with NE with or without associated reflux disease. It is important to diagnose reflux properly so patients can be treated adequately.
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Affiliation(s)
- Luiz Filipe Duarte Silva
- Gastroenterology Division, University Hospital Clementino Fraga Filho, Medicine Faculty, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
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Hata M, Shiono M, Sekino H, Furukawa H, Sezai A, Iida M, Yoshitake I, Hattori T, Wakui S, Taoka M, Negishi N, Sezai Y. Efficacy of a proton pump inhibitor given in the early postoperative period to relieve symptoms of hiatal hernia after open heart surgery. Surg Today 2006; 36:131-4. [PMID: 16440158 DOI: 10.1007/s00595-005-3108-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2004] [Accepted: 05/24/2005] [Indexed: 10/25/2022]
Abstract
PURPOSE To evaluate the efficacy of a proton pump inhibitor, we retrospectively reviewed patients who underwent gastric fiberscopy (GFS) in the early phase after cardiac surgery. METHODS The subjects were 103 patients who underwent GFS for poor appetite, gastric pain, heartburn, or hematemesis after cardiac surgery. We divided the patients into two groups: group I consisted of 49 patients who received an H2-receptor antagonist (ranitidine hydrochloride 300 mg/day), and group II consisted of 54 patients who received a proton pump inhibitor (PPI; sodium rabeprazole 10 mg/day) as prophylactic treatment. The incidence of upper gastrointestinal (GI) disease was compared in the two groups. RESULTS Gastric fiberscopy confirmed that 82.5% of the patients had type I hiatal hernia. The incidences of gastric pain and heartburn were significantly higher in group I (12.2% and 83.7%) than in group II (0% and 37.0%). Moreover, gastric bleeding occurred in two patients from group I, one [corrected] of whom died of coagulopathy. The incidences of hemorrhagic gastritis, active ulcer, and reflux esophagitis were significantly higher in group I than in group II, at 22.4%, 22.4%, and 24.5% vs 1.9%, 0%, and 7.4%. CONCLUSIONS Early postcardiotomy GFS confirmed a high incidence of type I hiatal hernia. However, the proton pump inhibitor given in the early postoperative period proved more effective than the H2-receptor antagonist for relieving GI symptoms and preventing upper GI disorders after cardiac surgery.
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Affiliation(s)
- Mitsumasa Hata
- Department of Cardiovascular Surgery, Nihon University School of Medicine, 30-1 Ooyaguchi, Kamimachi, Itabashi-ku, Tokyo, 173-8610, Japan
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Bredenoord AJ, Weusten BLAM, Timmer R, Smout AJPM. Intermittent spatial separation of diaphragm and lower esophageal sphincter favors acidic and weakly acidic reflux. Gastroenterology 2006; 130:334-40. [PMID: 16472589 DOI: 10.1053/j.gastro.2005.10.053] [Citation(s) in RCA: 103] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2005] [Accepted: 10/19/2005] [Indexed: 12/12/2022]
Abstract
BACKGROUND & AIMS In small hiatal hernias, the size of the hernia is variable. Intermittent complete reduction can be observed with high-resolution manometry as a transition from a double-peak (hernia) to a single-peak (reduced) high-pressure zone. The aim of this study was to investigate whether intermittent separation of the diaphragm and lower esophageal sphincter (LES) favors the occurrence of gastroesophageal reflux. METHODS In 16 patients with a small hiatal hernia (3 cm), prolonged high-resolution manometry was performed. Acid and weakly acidic reflux episodes were detected with pH-impedance monitoring. RESULTS The single pressure peak profile (reduced hernia) was present for 814 minutes (56.5% of total time), and the double peak profile (unreduced hernia) was present for 626 minutes (43.5% of total time). In all patients, both pressure profiles were observed. The transition rate between the 2 profiles was 7.5 +/- 0.9 per hour. More reflux occurred when the LES and diaphragm were separated versus the reduced hernia state (23.1 +/- 5.1 vs 12.2 +/- 2.4 episodes per hour, respectively; P < .05). The proportions of acidic reflux episodes during the single and double pressure peaks were similar (70% and 67%, respectively). In the two-pressure-zone state, there was an increase in all reflux mechanisms except transient LES relaxation. CONCLUSIONS In patients with a small hiatal hernia, intermittent reduction of the hernia occurs frequently. Spatial separation of the diaphragm and LES in the nonreduced state results in a 2-fold increase in acidic and weakly acidic reflux due to mechanisms other than transient LES relaxation.
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Affiliation(s)
- Albert J Bredenoord
- Department of Gastroenterology, Saint Antonius Hospital, Nieuwegein, The Netherlands.
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Agrawal A, Tutuian R, Hila A, Freeman J, Castell DO. Identification of hiatal hernia by esophageal manometry: is it reliable? Dis Esophagus 2005; 18:316-9. [PMID: 16197531 DOI: 10.1111/j.1442-2050.2005.00506.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Hiatal hernias are frequently diagnosed during upper endoscopy or barium radiography. They can also be identified based on the typical 'double high pressure zone' or 'double hump' during stationary manometric pull-through. This paper aims to compare manometric and endoscopic identification of hiatal hernias. We retrospectively reviewed records of patients who had an esophageal manometry performed in our laboratory between July 2002 and July 2003. We identified 153 patients (104 females, mean age 56 years) who had both an esophageal manometry and upper endoscopy. The manometric studies were reviewed looking for the characteristic double high-pressure zone characteristic of hiatal hernia. The endoscopic reports were reviewed for the independent identification of an hiatal hernia. Information on race, gender, presence of hiatal hernias, esophagitis, and symptoms during esophagogastroduodenoscopy (EGD) exams was recorded from the reports of patients who had both EGD and manometric studies at our institution. Of the 153 patients with both endoscopy and manometry, 11 (7%) had an hiatal hernia identified by manometry compared to 51 (33%) by endoscopy. Ten (91%) of the manometrically identified hiatal hernias were also seen on endoscopy. Compared to endoscopy (gold standard), esophageal manometry had a sensitivity of 20% and a specificity of 99% for detecting hiatal hernias. Manometric identification of an hiatal hernia is an infrequent finding with low sensitivity but high specificity compared to endoscopy.
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Affiliation(s)
- A Agrawal
- Digestive Diseases Center, Medical University of South Carolina, Charleston, South Carolina 29425, USA.
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Abstract
The prevalence of gastro-oesophageal reflux disease (GERD) in Asian populations is reported to be lower than that in Western populations. However, recent epidemiological studies suggest that the incidence of the disease is increasing, especially in Japan. Endoscopic studies show that the overall prevalence of reflux oesophagitis among the adult population in Japan is in the region of 14-16%. This is similar to the figure reported in Western countries. The increasing prevalence in Japan may be due to a number of factors including increasing awareness of the condition and improved diagnostic techniques. The majority of the diagnosed cases in Japan are mild and these account for the increase in prevalence of the condition. In contrast to the West, where the condition is more prevalent in male members of the population, there is a high incidence of GERD in elderly females in Japan. The increased incidence of kyphosis and osteoporosis in this population may lead to the development of hiatus hernia, a condition known to exacerbate the development of reflux disease. Furthermore, Japanese patients with endoscopically diagnosed GERD appear to be less likely to complain of typical reflux symptoms, such as heartburn and acid reflux than their Western counterparts. In view of the known relationship between asymptomatic GERD and the development of oesophageal cancers there is a strong case for increased vigilance in the detection of GERD in the Japanese population.
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Affiliation(s)
- K Fujimoto
- Department of Internal Medicine and Gastrointestinal Endoscopy, Saga Medical School, Nabeshima, Saga 549-8501, Japan.
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Abstract
BACKGROUND Many observers believe that gastro-oesophageal reflux disease is more common among white individuals compared with Asians and Afro-Caribbean subjects. AIM To perform a systematic review regarding geographical and ethnic factors in the prevalence of reflux symptoms, endoscopic oesophagitis, hiatus hernia and Barrett's oesophagus. RESULTS Differences in definitions and methodology make comparison between studies difficult. Overall, however, the community prevalence of reflux symptoms, as well as the prevalence of endoscopic oesophagitis, hiatus hernia and Barrett's oesophagus among patients undergoing upper endoscopy, were lower among Asian and Afro-Caribbean subjects compared with white individuals. There may also be a north-south gradient in the prevalence of gastro-oesophageal reflux disease among western countries. Gastro-oesophageal reflux disease may be moderately common in the Middle East. There are suggestions that the prevalence of gastro-oesophageal reflux disease is increasing in the Far East. CONCLUSIONS More data are required, especially from Africa, South America, the Middle East, and the Indian subcontinent. Suggestions are made regarding definitions and methodology to facilitate comparison between future studies from different countries.
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Affiliation(s)
- J Y Kang
- Department of Gastroenterology, St George's Hospital, London, UK.
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