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Hiatus hernia in healthy volunteers is associated with intrasphincteric reflux and cardiac mucosal lengthening without traditional reflux.
Gut 2017; 66(7):1208-1215Gut

Abstract

BACKGROUND AND AIMS

Hiatus hernia (HH) is a key mediator of gastro-oesophageal reflux disease but little is known about its significance in the general population. We studied the structure and function of the gastro-oesophageal junction in healthy volunteers with and without HH.

METHODS

We compared 15 volunteers with HH, detected by endoscopy or MRI scan, but without gastro-oesophageal reflux disease with 15 controls matched for age, gender and body weight. Jumbo biopsies were taken across the squamocolumnar junction (SCJ). High-resolution pH metry (12 sensors) and manometry (36 sensors) were performed upright and supine, before and after a meal. The SCJ was marked with an endoscopically placed clip and visualised fluoroscopically.

RESULTS

Cardiac mucosa was longer in volunteers with HH (3.5 vs 2.5 mm, p=0.01). There was no excessive acid reflux 5 cm above the upper border of the lower oesophageal sphincter (LOS) in either group but those with HH had short segment reflux 11 mm above the pH transition point after the meal when supine (pH<4 for 5.5% vs 0.3% of time, p=0.01). The SCJ and pH transition point were proximally displaced within the gastro-oesophageal junction in those with HH versus controls (p<0.05). The pH transition point was proximal to the peak LOS pressure point in HH subjects but distal to it in controls after the meal (p<0.05). When supine, the postprandial pH transition point crossed the SCJ in those with HH (p=0.03).

CONCLUSIONS

Healthy volunteers with HH have increased intrasphincteric reflux and lengthening of cardiac mucosa in the absence of traditional transsphincteric reflux.

Authors+Show Affiliations

Section of Gastroenterology, ICAMS, University of Glasgow, Glasgow, UK.Section of Gastroenterology, ICAMS, University of Glasgow, Glasgow, UK.Section of Gastroenterology, ICAMS, University of Glasgow, Glasgow, UK.Section of Gastroenterology, ICAMS, University of Glasgow, Glasgow, UK.University Department of Pathology, University of Glasgow, Glasgow, UK.Section of Gastroenterology, ICAMS, University of Glasgow, Glasgow, UK.Department of Radiology, Queen Elizabeth University Hospital, Glasgow, UK.Section of Gastroenterology, ICAMS, University of Glasgow, Glasgow, UK.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

27196581

Citation

Robertson, Elaine V., et al. "Hiatus Hernia in Healthy Volunteers Is Associated With Intrasphincteric Reflux and Cardiac Mucosal Lengthening Without Traditional Reflux." Gut, vol. 66, no. 7, 2017, pp. 1208-1215.
Robertson EV, Derakhshan MH, Wirz AA, et al. Hiatus hernia in healthy volunteers is associated with intrasphincteric reflux and cardiac mucosal lengthening without traditional reflux. Gut. 2017;66(7):1208-1215.
Robertson, E. V., Derakhshan, M. H., Wirz, A. A., Mitchell, D. R., Going, J. J., Kelman, A. W., ... McColl, K. E. L. (2017). Hiatus hernia in healthy volunteers is associated with intrasphincteric reflux and cardiac mucosal lengthening without traditional reflux. Gut, 66(7), pp. 1208-1215. doi:10.1136/gutjnl-2016-311553.
Robertson EV, et al. Hiatus Hernia in Healthy Volunteers Is Associated With Intrasphincteric Reflux and Cardiac Mucosal Lengthening Without Traditional Reflux. Gut. 2017;66(7):1208-1215. PubMed PMID: 27196581.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Hiatus hernia in healthy volunteers is associated with intrasphincteric reflux and cardiac mucosal lengthening without traditional reflux. AU - Robertson,Elaine V, AU - Derakhshan,Mohammad H, AU - Wirz,Angela A, AU - Mitchell,David R, AU - Going,James J, AU - Kelman,Andrew W, AU - Ballantyne,Stuart A, AU - McColl,Kenneth E L, Y1 - 2016/04/25/ PY - 2016/01/28/received PY - 2016/03/10/revised PY - 2016/03/27/accepted PY - 2016/5/20/pubmed PY - 2017/8/22/medline PY - 2016/5/20/entrez KW - GASTROESOPHAGEAL REFLUX DISEASE KW - GASTROINTESTINAL MOTILITY KW - HIATAL HERNIA SP - 1208 EP - 1215 JF - Gut JO - Gut VL - 66 IS - 7 N2 - BACKGROUND AND AIMS: Hiatus hernia (HH) is a key mediator of gastro-oesophageal reflux disease but little is known about its significance in the general population. We studied the structure and function of the gastro-oesophageal junction in healthy volunteers with and without HH. METHODS: We compared 15 volunteers with HH, detected by endoscopy or MRI scan, but without gastro-oesophageal reflux disease with 15 controls matched for age, gender and body weight. Jumbo biopsies were taken across the squamocolumnar junction (SCJ). High-resolution pH metry (12 sensors) and manometry (36 sensors) were performed upright and supine, before and after a meal. The SCJ was marked with an endoscopically placed clip and visualised fluoroscopically. RESULTS: Cardiac mucosa was longer in volunteers with HH (3.5 vs 2.5 mm, p=0.01). There was no excessive acid reflux 5 cm above the upper border of the lower oesophageal sphincter (LOS) in either group but those with HH had short segment reflux 11 mm above the pH transition point after the meal when supine (pH<4 for 5.5% vs 0.3% of time, p=0.01). The SCJ and pH transition point were proximally displaced within the gastro-oesophageal junction in those with HH versus controls (p<0.05). The pH transition point was proximal to the peak LOS pressure point in HH subjects but distal to it in controls after the meal (p<0.05). When supine, the postprandial pH transition point crossed the SCJ in those with HH (p=0.03). CONCLUSIONS: Healthy volunteers with HH have increased intrasphincteric reflux and lengthening of cardiac mucosa in the absence of traditional transsphincteric reflux. SN - 1468-3288 UR - https://www.unboundmedicine.com/medline/citation/27196581/Hiatus_hernia_in_healthy_volunteers_is_associated_with_intrasphincteric_reflux_and_cardiac_mucosal_lengthening_without_traditional_reflux_ L2 - http://gut.bmj.com/cgi/pmidlookup?view=long&amp;pmid=27196581 DB - PRIME DP - Unbound Medicine ER -