Síntomas, hallazgos radiológicos, endoscópicos y estudios funcionales del esófago en pacientes con hernia hiatal mayor a 5 cm / Clinical and functional features of patients with a hiatal hernia diagnosed during endoscopy

Background: the finding of a hiatal hernia is usual during upper gastrointestinal endoscopies. However the correlation of symptoms, manometric and radiological findings with the endoscopy report is far from clear. Aim: to assess radiological findings, 24 pH measurements, esophageal manometry and symptoms among patients in whom a hiatal hernia was found during an upper gastrointestinal endoscopy. Material and Methods: one hundred fifteen patients aged 23 to 82 years (77 women), with an endoscopic diagnosis of a hiatal hernia of more than 5 cm were studied. An esophageal manometry and 24 hour pH determination were carried out. Results: hiatal hernias type I, II, II and IV were found in 50, 12, 38 and 15 patients of similar age, respectively. Gastroesophageal reflux symptoms were more common among patients with hernias type I and III. Mechanical symptoms such as retrosternal pain were more common in type IV hernias. Manometry showed a hypotensive sphincter in 100 and 78 percent of patients with hernias type I and III, respectively. An abnormal 24 hour pH measurement was found in 95 and 85 percent of patients with hernias type I and III, respectively. Conclusions: functional studies show a high frequency of pathological acid reflux among patients with hiatal hernias type I and III.

El hallazgo de una hernia hiatal durante un estudio endoscópico se informa frecuentemente. Sin embargo, no hay referencias específicas acerca de los síntomas y los trastornos funcionales del esófago según el tipo de hernia hiatal. Objetivo: determinar los síntomas predominantes, los hallazgos radiológicos y endoscópicos y de los estudios funcionales en pacientes con los diferentes tipos de hernia hiatal. Método: se evaluaron 115 pacientes, todos con diagnóstico radiológico de hernia hiatal mayor a 5 cm, realizando estudios endoscópicos, histológicos y manometría esofágica, junto a pHmetría de 24 h. Resultados: la edad fue similar en los 4 tipos de hernia hiatal. Síntomas de reflujo gastroesofágico se presentaron con gran frecuencia en hernias tipo I y III, mientras que síntomas mecánicos se manifestaron en hernias tipo IV. El estudio manométrico mostró un esfínter hipotensivo junto con reflujo ácido patológico en casi 90 por ciento de las hernias tipo I y IIII. Conclusión: el estudio más útil para el diagnóstico de hernia hiatal es el radiológico. La endoscopia es necesaria para comprobar el daño de la mucosa esofágica. Los estudios funcionales muestran una alta prevalencia de reflujo ácido patológico en hernias hiatales tipo I y II.

Maior prevalência de obesidade na doença do refluxo gastroesofagiano erosiva / Higher prevalence of obesity in erosive gastroesophageal reflux disease

CONTEXTO: Existe uma noção geral de que indivíduos obesos desenvolvem mais freqüentemente a doença do refluxo gastroesofagiano, sendo a orientação de perder peso parte integrante do seu tratamento. Entretanto, uma base científica para esta associação não está plenamente estabelecida. OBJETIVOS: Avaliar a prevalência de obesidade e sobrepeso em pacientes com sintomas típicos de refluxo, com e sem esofagite erosiva. Analisar a prevalência de hérnia hiatal e a intensidade do refluxo anormal em relação ao índice de massa corporal nos dois grupos de pacientes. MÉTODOS: Foram examinadas retrospectivamente 362 pHmetrias de pacientes com pirose, todos com endoscopia digestiva alta prévia, definindo-se esofagite erosiva pela presença de erosões esofagianas macroscópicas e hérnia de hiato quando à junção esôfago-gástrica estava 2 cm ou mais acima do pinçamento diafragmático. Pacientes com esôfago de Barrett ou estenose péptica foram excluídos. A população foi dividida em três grupos de acordo com o índice de massa corpórea: peso normal, com índice de massa corporal entre 20 e 24,9, sobrepeso, com 25 e 29,9 e obesos com índice superior a 30. O diagnóstico de refluxo gastroesofagiano anormal com sua intensidade foi avaliado de acordo com os resultados de pHmetrias, analisados nos grupos de pacientes com e sem esofagite erosiva em relação ao índice de massa corporal. RESULTADOS: Entre os 362 pacientes, havia 148 (41 por cento) com e 214 (59 por cento) sem esofagite erosiva, sendo a pHmetria anormal em 100 por cento e 57 por cento dos pacientes, retrospectivamente. Entre os 148 (61 por cento do sexo masculino, mediana de idade de 50 anos), 41 (28 por cento) apresentavam peso normal, 82 (55 por cento) sobrepeso e 25 (17 por cento) eram obesos. Havia 88 (60 por cento) com hérnia hiatal, sendo 29 (71 por cento dos pacientes com peso normal), 45 (55 por cento dos com sobrepeso) e 14 (56 por cento dos obesos). Nos 121 indivíduos sem esofagite erosiva e...

CONTEXT: Weight loss is commonly recommended as a treatment for gastroesophageal reflux; however, a relationship between excessive body weight and gastroesophageal reflux disease is not well established. OBJECTIVES: To evaluate the prevalence of obesity and over-weight in patients with heartburn, with and without erosive esophagitis; to analyze the prevalence of hiatal hernia and the intensity of abnormal gastroesophageal reflux in both groups of patients, and its relation to body mass index. METHODS: The data of pH monitoring of 362 individuals with heartburn were evaluated retrospectively. All patients had an upper gastrointestinal endoscopy and erosive esophagitis was defined by the presence of macroscopic erosion on the esophageal mucosa. Hiatal hernia was considered when the gastroesophageal junction was positioned 2 cm or more above the diaphragm. Patients with Barrett's esophagus or esophageal peptic stenosis were excluded. The population was categorized according to body mass index as normal weight (body mass index between 20 and 24.9); over-weight (between 25 and 29.9), and obese (greater than 30). The diagnosis as well as the intensity of abnormal gastroesophageal reflux were obtained through the analysis of the results of pH monitoring in patients with and without erosive esophagitis and in the various categories of body mass index. RESULTS: Among the 362 patients there were 148 (41 percent) with erosive esophagitis and 214 (59 percent) without erosive esophagitis, while the pH monitoring was abnormal in 100 percent and 57 percent, respectively. Among the 148 individuals with erosive esophagitis (61 percent male, median age 50 years), 41 (28 percent) had normal weight, 82 (55 percent) had over-weight and 25 (17 percent) were obese. There were 88 (60 percent) patients with hiatal hernia, which was present in 29 (71 percent of patients with normal weight), 45 (55 percent of patients with over-weight) and 14 (56 percent of obese...

The Prevalence of Esophageal Disorders in the Subjects Examined for Health Screening / 대한소화기학회지

BACKGROUND/AIMS: Various disorders can be developed in the esophagus. However, esophagus has been less well focused than other gastrointestinal (GI) tracts since the esophageal disorders are relatively uncommon. There has been no report on the prevalence of overall esophageal disorders in Korea. The aim of this study was to evaluate the prevalence of esophageal disorders in health examinee. METHODS: We reviewed retrospectively the endoscopic reports of 6,683 subjects who underwent upper GI endoscopy for screening purpose at Gyeongsang National University Hospital from March, 2005 to May, 2006. RESULTS: Among 6,683 health examinee, 1,154 (17.26%) had esophageal diseases. Gastro-esophageal reflux diseases (GERD) were the most common diseases (14.66%). The prevalence of erosive reflux esophagitis, minor change esophagitis, and Barrett's esophagus was 8.45%, 5.01% and 1.12%, respectively. Hiatal hernia and esophageal submucosal tumor were 2nd and 3rd common diseases (2.0% and 0.6%, respectively). A variety of other esophageal disorders were seen as well. The esophageal disorders with over 0.1% of prevalence were esophageal varices (0.37%), esophageal squamous papilloma (0.31%), esophageal candidiasis (0.25%), nonspecific esophagitis (0.16%), heterotopic gastric mucosa (0.16%), and esophageal vascular ectasia (0.12%) in order. CONCLUSIONS: The overall prevalence of esophageal disorders among health examinee was 17.3%. The GERD was the main esophageal disease and a variety of esophageal diseases were identified. The endoscopists need to take an interest in the esophageal disorders and a community-oriented well organized study should be warranted.

Endoscopically Observed Lower Esophageal Capillary Patterns

BACKGROUND: It has been reported that there are four zones of distinct venous patterns around the gastroesophageal junction (GEJ); i.e. truncal, perforating, palisade (PZ) and gastric zones. Using the distal end of PZ as a marker for GEJ, this study was done to assess the length and patterns of PZ in Koreans, and to assess the prevalence of endoscopic Barrett's esophagus (E-BE) and hiatal hernia (E-HH). METHODS: 847 consecutive patients undergoing diagnostic endoscopy were included. During endoscopy, PZ, squamocolumnar junction (SCJ) and pinchcock action (PCA) were identified. Patterns were classified according to the relationships of the distal end of PZ with SCJ and PCA; A: all three at the same level, B: SCJ proximal to the other two which are at the same level, C: PCA distal to the other two which are at the same level, D: SCJ proximal to the distal end of PZ which is proximal to PCA. Cases with patterns B and D were thought to have E-BE, and those with patterns C and D to have E-HH. RESULTS: Patterns A, B, C and D were 79.2%, 12.1%, 3.8% and 4.9%, respectively. Length of PZ was 3.0+/-0.1 cm. E-BE and E-HH were found in 17.0% and 8.7%, respectively. Both E-BE and E-HH were more frequently found in males and in cases with reflux esophagitis. CONCLUSION: E-BE and E-HH are not so infrequent in Koreans as previously thought, if we use the distal end of PZ as an endoscopic marker of GEJ.

La hernia hiatal en pacientes asmáticos: prevalencia y su asociación con reflujo gastroesofágico / Hiatal hernia in asthmatic patients: prevalence of and its association to gastroesophageal reflux

Antecedentes. Se ha informado que existe una alta prevalencia de hernia hiatal y reflujo gastroesofágico en asmáticos, pero en México no contamos con estudios al respecto. La relación entre hernia hiatal y reflujo gastroesofágico en asmáticos no ha sido estudiada. Objetivos. 1) conocer la prevalencia de hernia hiatal en asmáticos, 2) comparar la prevalencia de hernia hiatal en asmáticos frente a sujetos no asmáticos, 3) establecer la posible asociación de la hernia hiatal con el reflujo gastroesofágico en enfermos asmáticos. Material y métodos. Se practicó endoscopia a pacientes asmáticos y no asmáticos para conocer y comparar la prevalencia de hernia hiatal. Con el fin de establecer la posible asociación entre asma y reflujo gastroesofágico se analizaron los resultados de un cuestionario de síntomas gastrointestinales, manometría esofágica y pH-metría en asmáticos con y sin hernia hiatal. Resultados. La prevalencia de hernia hiatal en asmáticos fue alta y significativa mayor a la detectada en no asmáticos (62 vs. 34 por ciento, p= 0.002). La frecuencia de síntomas típicos de reflujo gastroesofágico fue similar en asmáticos con y sin hernia hiatal (54 vs. 43 por ciento, p=0.3). La manometría detectó incompetencia del esfínter esofágico inferior en una proporción semejante de asmáticos con hernia hiatal (35 por ciento) y sin hernia hiatal (22 por ciento) (p=0.4). Se detectó reflujo gastroesofágico patológico mediante pH-metría en 81 por ciento de los asmáticos con hernia hiatal y en 65 por ciento de aquéllos sin hernia hiatal (p=0.1). Conclusiones. La prevalencia de hernia hiatal en asmáticos es elevada y mayor a la encontrada en sujetos no asmáticos. La presencia de hernia hiatal no se correlaciona con la detección de reflujo gastroesofágico patológico por pH-metría en este grupo de enfermos

Importância do fator etário no determinismo da hérnia hiatal por deslizamento e a doença do refluxo gastroesofagiano: estudo transversal / The importance of age factor in the relationship between hiatus hernia and gastroesophageal reflux disease: cross-sectional study

Foram selecionados transversalmente 77 pacientes portadores de doenças do refluxo gastroesofagiano segundo critérios rigorosos de pHmetria esofagiana ambulatorial de 24 h e distribuído em três grupos etários: grupo A = 14 e = 24 anos, grupo B = 25 e = 54 anos e grupo C = 55 e = 64 anos. A pHmetria esofagiana ambulatorial de 24 h foi realizada segundo a padronização de DeMeester e para diagnóstico da hérnia hiatal por deslizamento utilizou-se endoscopia digestiva alta. Os grupos foram semelhantes em parâmetros da pHmetria esofagiana ambulatorial de 24 h (p>0.05 NS) cujas valores médios estavam acima da normalidade. A incidência de hérnia hiatal por deslizamento foi: grupo A: 10,00 por cento; grupo B: 43,40 por cento; grupo C: 64,29 por cento. A comparação entre grupos etários diferentes com parâmetros semelhantes de refluxo ácido pode fornecer dados evolutivos da doença do refluxo gastroesofagiano. Os achados reforçam que essa é uma doença crônica e sem resolução espontânea. Pondera-se que, além do envelhecimento, a agressão ácida continuada do esôfago distal contribua para queda dos mecanismos de defesa locais. A diferença significativa de incidência de hérnia hiatal por deslizamento observada nos grupos etários estudados seria devido a outros fatores individuais que não a idade cronológica.

Reflux esophagitis and its relationship to hiatal hernia

We performed this study to evaluate the prevalence of reflux esophagitis and/or hiatal hernia in patients referred to a medical center and to examine the relationship between endoscopic reflux esophagitis and hiatal hernia. The study was carried out in 1,010 patients referred to Yong Dong Severance Hospital for upper gastrointestinal endoscopy because of symptoms related to the gastrointestinal tract from September 1994 to March 1996. The presence of hiatal hernia was defined as a circular extension of the gastric mucosa of 2 cm or more above the diaphragmatic hiatus. Reflux esophagitis was found in 5.3% of patients, hiatal hernia in 4.1%, duodenal ulcer in 7.2% and gastric ulcer in 8.2%. The prevalence rates of reflux esophagitis and hiatal hernia in males were significantly higher than those in females. Thirty-two percent of patients with reflux esophagitis had hiatal hernia. In patients without reflux esophagitis, hiatal hernia was found in only 2.5% (p<0.01). There was no significant association between the presence of hiatal hernia and the degree of esophagitis on endoscopy. Duodenal ulcer was the second most common endoscopic abnormality found in patients with reflux esophagitis. The prevalence rate of reflux esophagitis and/or hiatal hernia at a medical center is relatively low compared to peptic ulcer disease and other reports from the Western countries. Our study confirms the close association between reflux esophagitis and hiatal hernia.

Hernia hiatal y su relacion con la ingestion de fibra dietetica / Diaphramatic hernia and its relation to dietary fiber intake

Se estudiaron 226 pacientes con diagnostico de hernia hiatal por radiologia, endoscopia y manometria esofagica y 200 controles normalespara determinar la cantidad de fibra dietetica ingerida y su relacion con la hernia hiatal. Se encontro que los pacientes que presentaron hernia hiatal consumian menos cantidad de fibra dietetica que los controles, lo cual fue demostrado estadisticamente

Valoración pre y postoperatoria de las mediciones objetivas del reflujo gastroesofágico / Pre and postoperative evalution of gastroesopagheal reflux tests

En 25 pacientes se evaluaron antes y después de efectuar operación de Hill modificada, seriada esopagogastroduodenal, esofagogastroduodenoscopia, biopsia de mucosa del esófago inferior, esofagomanometría, "test" de reflujo ácido estándar y acidimetría basal y post-estímulo. Se considera que la biopsia, la manometría y el "test" fueron los métodos de mayor utilidad para el diagnóstico de esofagitis por reflujo y su control postoperatorio.