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[Sliding hiatal hernia in patients with gastroesophageal reflux: physiopathology and surgical treatment].
Minerva Chir 2000; 55(6):415-20MC

Abstract

BACKGROUND

The aims of the study were to evaluate how the sliding hiatal hernia, in patients with gastroesophageal reflux disease (GERD), acts on the lower esophageal sphincter (LES) and esophageal clearance, and how surgical therapy corrects the physiopathological parameters.

METHODS

Records of 25 patients with only GERD and of 15 with GERD associated to hiatal hernia (> 3.5 cm) were reviewed. Ten subjects without symptoms and/or endoscopic and functional signs of GERD were considered as control group. The selection of the patients was done by reviewing radiographic examination, endoscopy and functional tests (esophageal manometry, pH-monitoring).

RESULTS

Manometry showed a greater LES incompetence (pressure and length) and a worse peristalsis (distal amplitude) in the group with reflux and hiatal hernia against patients with reflux only. Also, patients with hiatal hernia had more acid exposure (total time pH < 4 in the distal esophagus) and a longer time of esophageal clearance, at pH-monitoring. The functional tests in 8 patients, before and after laparoscopic Toupet fundoplication with posterior closing of the crura, showed a normalised LES, esophageal clearance and acid exposure. Esophageal peristalsis did not show any statistically significance.

CONCLUSIONS

The presence of hiatal hernia, in patients with GERD, causes worse LES, peristalsis and clearance with a greater acid exposure of the esophagus. Fundoplication, by reconstructing the sphincter-diaphragm unit, normalises the preoperative physiopathology situation but without an effective peristalsis improvement.

Authors+Show Affiliations

Cattedra di Chirurgia Generale, Università degli Studi, Udine. Vittorio.Bresadola@DSC.UNIUD.ITNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
English Abstract
Journal Article

Language

ita

PubMed ID

11059235

Citation

Bresadola, V, et al. "[Sliding Hiatal Hernia in Patients With Gastroesophageal Reflux: Physiopathology and Surgical Treatment]." Minerva Chirurgica, vol. 55, no. 6, 2000, pp. 415-20.
Bresadola V, Noce L, Ventroni MG, et al. [Sliding hiatal hernia in patients with gastroesophageal reflux: physiopathology and surgical treatment]. Minerva Chir. 2000;55(6):415-20.
Bresadola, V., Noce, L., Ventroni, M. G., Vianello, V., Intini, S., & Bresadola, F. (2000). [Sliding hiatal hernia in patients with gastroesophageal reflux: physiopathology and surgical treatment]. Minerva Chirurgica, 55(6), pp. 415-20.
Bresadola V, et al. [Sliding Hiatal Hernia in Patients With Gastroesophageal Reflux: Physiopathology and Surgical Treatment]. Minerva Chir. 2000;55(6):415-20. PubMed PMID: 11059235.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - [Sliding hiatal hernia in patients with gastroesophageal reflux: physiopathology and surgical treatment]. AU - Bresadola,V, AU - Noce,L, AU - Ventroni,M G, AU - Vianello,V, AU - Intini,S, AU - Bresadola,F, PY - 2000/11/4/pubmed PY - 2001/2/28/medline PY - 2000/11/4/entrez SP - 415 EP - 20 JF - Minerva chirurgica JO - Minerva Chir VL - 55 IS - 6 N2 - BACKGROUND: The aims of the study were to evaluate how the sliding hiatal hernia, in patients with gastroesophageal reflux disease (GERD), acts on the lower esophageal sphincter (LES) and esophageal clearance, and how surgical therapy corrects the physiopathological parameters. METHODS: Records of 25 patients with only GERD and of 15 with GERD associated to hiatal hernia (> 3.5 cm) were reviewed. Ten subjects without symptoms and/or endoscopic and functional signs of GERD were considered as control group. The selection of the patients was done by reviewing radiographic examination, endoscopy and functional tests (esophageal manometry, pH-monitoring). RESULTS: Manometry showed a greater LES incompetence (pressure and length) and a worse peristalsis (distal amplitude) in the group with reflux and hiatal hernia against patients with reflux only. Also, patients with hiatal hernia had more acid exposure (total time pH < 4 in the distal esophagus) and a longer time of esophageal clearance, at pH-monitoring. The functional tests in 8 patients, before and after laparoscopic Toupet fundoplication with posterior closing of the crura, showed a normalised LES, esophageal clearance and acid exposure. Esophageal peristalsis did not show any statistically significance. CONCLUSIONS: The presence of hiatal hernia, in patients with GERD, causes worse LES, peristalsis and clearance with a greater acid exposure of the esophagus. Fundoplication, by reconstructing the sphincter-diaphragm unit, normalises the preoperative physiopathology situation but without an effective peristalsis improvement. SN - 0026-4733 UR - https://www.unboundmedicine.com/medline/citation/11059235/[Sliding_hiatal_hernia_in_patients_with_gastroesophageal_reflux:_physiopathology_and_surgical_treatment]_ L2 - http://www.diseaseinfosearch.org/result/2996 DB - PRIME DP - Unbound Medicine ER -