Excess gastroesophageal reflux in patients with hiatus hernia is caused by mechanisms other than transient LES relaxations

Herwaarden, Margot A. van; Samsom, Melvin; Smout, A. J. P. M.

doi:10.1016/s0016-5085(00)84081-0

Cited by 48 publications

(100 citation statements)

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“…However, what constitutes significant reflux is unclear in both the pulmonary [29] and the gastroenterology literature [35]. Several studies in non-IPF cases demonstrate that HH may result in a compromised LOS, leading to higher prevalence of refluxate, which may be acidic or non-acidic and either symptomatic or asymptomatic [15,36,37]. Whether a non-acidic asymptomatic refluxate is clinically meaningful is unknown.…”

Section: Pulmonary Fibrosis I Noth Et Almentioning

confidence: 99%

Prevalence of hiatal hernia by blinded multidetector CT in patients with idiopathic pulmonary fibrosis

Noth

Zangan

Soares

et al. 2011

European Respiratory Journal

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Hiatal hernia (HH) is associated with gastro-oesophageal reflux (GOR) and/or GOR disease and may contribute to idiopathic pulmonary fibrosis (IPF). We hypothesised that HH evaluated by computed tomography is more common in IPF than in asthma or chronic obstructive pulmonary disease (COPD), and correlates with abnormal GOR measured by pH probe testing.Rates of HH were compared in three cohorts, IPF (n5100), COPD (n560) and asthma (n524), and evaluated for inter-observer agreement. In IPF, symptoms and anti-reflux medications were correlated with diffusing capacity of the lung for carbon monoxide (DL,CO) and composite physiologic index (CPI). HH was correlated with pH probe testing in IPF patients (n514).HH was higher in IPF (39%) than either COPD (13.3%, p50.00009) or asthma (16.67%, p50.0139). The HH inter-observer k agreement was substantial in IPF (k50.78) and asthma (k50.86), and moderate in COPD (k50.42). In IPF, HH did not correlate with lung function, except in those on anti-reflux therapy, who had a better DL,CO (p,0.03) and CPI (p,0.04). HH correlated with GOR as measured by DeMeester scores (p,0.04).HH is more common in IPF than COPD or asthma. In an IPF cohort, HH correlated with higher DeMeester scores, confirming abnormal acid GOR. Presence of HH alone was not associated with decreased lung function.

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Section: Pulmonary Fibrosis I Noth Et Almentioning

confidence: 99%

Prevalence of hiatal hernia by blinded multidetector CT in patients with idiopathic pulmonary fibrosis

Noth

Zangan

Soares

et al. 2011

European Respiratory Journal

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“…It may diminish lower esophageal sphincter pressure, promote acid reflux and compromise emptying of the refluxate from the distal esophagus, prolonging acid contact with the esophageal mucosa [19-21], a mechanism that could explain the association of HH with more severe reflux [22,23]. Thus, although HH has been established as the strongest predictor of the presence and severity of esophagitis in GERD patients with esophagitis, there are no published data on the role of HH in symptomatic patients without endoscopic esophagitis.…”

Section: Discussionmentioning

confidence: 99%

Impact of hiatal hernia on histological pattern of non-erosive reflux disease

et al. 2005

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BackgroundHiatus hernia (HH) has major pathophysiological effects favoring gastroesophageal reflux and hence contributing to esophageal mucosa injury, especially in patients with severe gastroesophageal disease. However, prospective studies investigating the impact of HH on the esophageal mucosa in non-erosive reflux disease (NERD) are lacking. This study evaluated the association between the presence of (HH) and the histological findings in symptomatic patients with NERD.MethodsFifty consecutive patients with gastroesophageal reflux disease (GERD) were enrolled. After conventional endoscopy, Lugol solution was applied and biopsy specimens were obtained. Histological parameters including basal zone hyperplasia, papillary length and cellular infiltration were evaluated. The chi-square test with Yates' correlation was used for comparing discrete parameters between groups. However, Fisher's exact probability test was used where the expected frequencies were lower than 5. Wilcoxon's test for unpaired samples was preferred in cases of semi-quantitative parameters.ResultsThe presence of HH along with more severe findings (0.01

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“…In our study population, the presence of hiatal hernia was associated more frequently with a picture of reflux with esophagitis. Hiatal hernia is currently assumed to be one of the physiopathological factors contributing to the onset of GERD by reducing LES competence and interfering with esophageal clearance [17,18] . Hiatal hernia is apparently a dominant predictor of erosive esophagitis [19] but it has been little studied in patients with NERD who are less likely to have hiatal hernias than patients with esophagitis [14,5,20] .…”

Section: General Considerations: Study Populationmentioning

confidence: 99%

Non-erosive and uncomplicated erosive reflux diseases: Difference in physiopathological and symptom pattern

Bresàdola¹

2011

WJGP

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AIM: To investigate differences in the physiopathological findings (manometry and pH monitoring) and symptoms between cases of non-erosive reflux disease (NERD) and erosive reflux disease (ERD) found positive at 24 h pH monitoring. METHODS:For a total of 670 patients who underwent 24 h pH monitoring, esophageal manometry and upper endoscopy were retrospectively evaluated, assessing the reflux symptoms, manometric characteristics of the lower esophageal sphincter (LES) and esophageal body and the presence or absence of esophagitis and hiatal hernia. Typical and atypical symptoms were also evaluated. For inclusion in the study, patients had to have NERD or ERD and be found positive on pH monitoring (NERD+). Patients with Gastroesophageal reflux disease (GERD) complicated by stenosis, ulcers or Barrett's esophagus were ruled out.RESULTS: 214 patients were involved in the study, i.e. 107 cases of NERD+ and 107 of ERD. There were no significant gender-or age-related differences between the two groups. The ERD group had more cases of hiatal hernia (P = 0.02) and more acid reflux, both in terms of number of reflux episodes (P = 0.01) and as a percentage of the total time with a pH < 4 (P = 0.00), when upright (P = 0.007) and supine (P = 0.00). The NERD+ cases had more reflux episodes while upright (P = 0.02) and the ERD cases while supine (P = 0.01). The LES pressure was higher in cases of NERD+ (P = 0.03) while the amplitude and duration of their esophageal peristaltic waves tended to be better than in the ERD group (P >0.05). The NERD+ patients presented more often with atypical symptoms (P = 0.01). CONCLUSION:The NERD+ patients' fewer reflux episodes and the fact that they occurred mainly while in the upright position (unlike the cases of ERD) may be two factors that do not favor the onset of esophagitis. The frequently atypical symptoms seen in patients with NERD+ need to be accurately evaluated for therapeutic purposes because patients with GERD and atypical symptoms generally respond only partially to medical and surgical treatments.

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Excess gastroesophageal reflux in patients with hiatus hernia is caused by mechanisms other than transient LES relaxations

Cited by 48 publications

References 0 publications

Prevalence of hiatal hernia by blinded multidetector CT in patients with idiopathic pulmonary fibrosis

Prevalence of hiatal hernia by blinded multidetector CT in patients with idiopathic pulmonary fibrosis

Impact of hiatal hernia on histological pattern of non-erosive reflux disease

Non-erosive and uncomplicated erosive reflux diseases: Difference in physiopathological and symptom pattern

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