Changes in lung volumes and gas trapping in patients with large hiatal hernia

Naoum, Christopher; Kritharides, Leonard; Ing, Alvin; Falk, Gregory L.; Yiannikas, John

doi:10.1111/crj.12314

Cited by 15 publications

(29 citation statements)

References 31 publications

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“…Airway narrowing and closure lead to gas trapping and ventilation inhomogeneity [38]. While gas trapping and airway closure can be inferred from an elevated RV/TLC ratio [39], a recently developed method to assess airway closure is oscillometric evaluation of respiratory system impedance. In a comparative study of lung mechanics in obese versus non-obese people with asthma, Salome et al found that obesity does not alter methacholine responsiveness measured by spirometry but significantly reduces respiratory system reactance and increases respiratory system resistance (Rrs) [32].…”

Section: The Effect Of Obesity On Airway Narrowing and Airway Closurementioning

confidence: 99%

The effect of obesity on lung function

Dixon

Peters

2018

Expert Review of Respiratory Medicine

554

442

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There is a major epidemic of obesity, and many obese patients suffer with respiratory symptoms and disease. The overall impact of obesity on lung function is multifactorial, related to mechanical and inflammatory aspects of obesity. Areas covered: Obesity causes substantial changes to the mechanics of the lungs and chest wall, and these mechanical changes cause asthma and asthma-like symptoms such as dyspnea, wheeze, and airway hyperresponsiveness. Excess adiposity is also associated with increased production of inflammatory cytokines and immune cells that may also lead to disease. This article reviews the literature addressing the relationship between obesity and lung function, and studies addressing how the mechanical and inflammatory effects of obesity might lead to changes in lung mechanics and pulmonary function in obese adults and children. Expert commentary: Obesity has significant effects on respiratory function, which contribute significantly to the burden of respiratory disease. These mechanical effects are not readily quantified with conventional pulmonary function testing and measurement of body mass index. Changes in mediators produced by adipose tissue likely also contribute to altered lung function, though as of yet this is poorly understood.

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Section: The Effect Of Obesity On Airway Narrowing and Airway Closurementioning

confidence: 99%

The effect of obesity on lung function

Dixon

Peters

2018

Expert Review of Respiratory Medicine

554

442

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“…This strategy is supported by an only modest observed improvement in pulmonary function tests after hernia repair. Objectively, there was significant post-operative increase in TLC and VC, with no significant alteration in the RV (4,9). Improvements in TLC and VC were proposed secondary to the physical removal of gastric tissue from the thoracic cavity.…”

Section: Discussionmentioning

confidence: 99%

“…Differences were observed between the ITS categories, with an increase in post-operative TLC in the overall group and patients (9). The FVC and FEV 1 are other objective pulmonary functions which showed significant improvement in the majority of studies (4,5,9). Improvement of the FVC and FEV 1 theoretically represent the relief of both airway obstruction due to gastric compression of respiratory outlets and decreased restriction due to increased volume available for lung expansion (4).…”

Section: Discussionmentioning

confidence: 99%

“…However, it is unclear from the current literature whether the size of paraesophageal hernias has any direct correlation with severity of dyspnea and variations in PFTs. It is also unclear whether paraesophageal hernia repair results in improvement in pulmonary function, or just subjective dyspnea (4)(5)(6). This systematic review was performed to understand the relation between paraesophageal hernia repair and the subjective and objective improvements in pulmonary function.…”

Section: Introductionmentioning

confidence: 99%

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Impact of Paraesophageal Hernia Repair on Respiratory Function: A Systematic Review

et al. 2021

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Background and Objectives: Surgical repair of hiatal and paraesophageal hernia is widely accepted for the treatment of gastroesophageal reflux symptoms. The respiratory benefit of this surgery is less clear. The objective of this review is to quantify the benefit to pulmonary function and subjective dyspnea of paraesophageal hernia repair with the aim of refining the indications and contraindications for elective paraesophageal hernia repair.Methods: Articles were gathered from systematic searches of the Medline Complete Database via the Creighton University Health Sciences Library literature search services. Publications with both pre and postoperative pulmonary function data or both pre and postoperative subjective dyspnea data with regards to surgical paraesophageal hernia repair were included.Results: Six studies were included in this review. The majority of studies in this review show improvement in pulmonary function postoperatively with regards to FEV1, FVC, and VC when stratified by % intrathoracic stomach (ITS), particularly in groups >50% ITS. No significant change was seen in postoperative DLCO or FEV1/FVC.Conclusion: Paraesophageal hernia repair has shown to improve pulmonary function both objectively and subjectively. This review was limited by the paucity of literature on the subject as well as the lack of a standardized method for measurement of %ITS.

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“…Indeed, plethysmograph tends to count as TGV any air that is within the thoracic cage as it is compressed by the panting manoeuver 1. We usually think that only the air volume being above the diaphragm is counted but in case of diaphragmatic hernia, hiatal hernia2 or major colonic dilation,3 subdiaphragmatic air being forced up into the thoracic cage is also taken into account. In the present case, TGV measured both intrathoracic gases, which increased after colonic exsufflation, and subdiaphragmatic gases, decreased by exsufflation, resulting in a non-significant change in TGV.…”

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confidence: 99%