Hiatal Hernia and Gastroesophageal Reflux

Stilson, Walter L.; Sanders, Isaac; Gardiner, G.A.; Gorman, Henry C.; Lodge, Dail F.

doi:10.1148/93.6.1323

Cited by 66 publications

(3 citation statements)

References 3 publications

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“…A hypotensive LES is uncommon in GERD; studies show decreased LES pressure in only 4 to 25% of patients, 22 , 23 but these studies do not address older people specifically. Hiatal hernia is more common in patients more than age 60 24 and may play a role in making esophagitis more severe in older people (see below). Ineffective esophageal motility (IEM), a manometric abnormality characterized by decreased amplitude of esophageal contraction (<30 mm Hg) in more than 30% of swallows, is the most common manometric abnormality in GERD, seen in about 35% of patients 25 , 26 .…”

Section: Pathogenesismentioning

confidence: 99%

Gastroesophageal Reflux Disease

Katz

1998

J American Geriatrics Society

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Gastroesophageal reflux disease (GERD) is a spectrum of disease that can best be defined as the symptoms and/or signs of esophageal or adjacent organ injury secondary to the reflux of gastric contents into the esophagus or, beyond, into the oral cavity or airways. Injury is defined based on symptoms or organ damage resulting in esophagitis, laryngeal inflammation, or acute and/or chronic pulmonary injury. Though specific studies are lacking, GERD seems to occur more frequently in older people. In general, because it has been present for a longer period of time, older patients will often present with more complicated GERD, including severe erosive esophagitis, peptic stricture, and Barrett's esophagus, a premalignant condition, making treatment of older patients with GERD potentially more difficult and complex. Though it is not usually life-threatening, GERD can have a major effect on patients' well-being and quality of life. This article reviews the presentation, pathophysiology, diagnosis, and treatment of GERD as it relates to the older patient.

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Section: Pathogenesismentioning

confidence: 99%

Gastroesophageal Reflux Disease

Katz

1998

J American Geriatrics Society

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“…GERD ethiopatogenesis is certainly multifactorial with alterations that include a less effective antireflux barrier, defective esophageal-clearance, altered esophageal mucosal resistance, and delayed gastric emptying [11]. Hiatal hernia as a structural defect of the antireflux barrier is a determining factor of GERD, by impairing both the diaphragmatic component and the clearance of acid refluxate from the distal esophagus [12-17]. GERD has nearly the same prevalence among elderly and young people, but older patients have more severe esophageal mucosal injuries like grade 3 or 4 esophagitis and Barrett disease [18-23].…”

Section: Discussionmentioning

confidence: 99%

Is the advanced age a contraindication to GERD laparoscopic surgery? Results of a long term follow-up

et al. 2013

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BackgroundIn this prospective non randomized observational cohort study we have evaluated the influence of age on outcome of laparoscopic total fundoplication for GERD.MethodsSix hundred and twenty consecutive patients underwent total laparoscopic fundoplication for GERD. Five hundred and twenty-four patients were younger than 65 years (YG), and 96 patients were 65 years or older (EG). The following parameters were considered in the preoperative and postoperative evaluation: presence, duration, and severity of GERD symptoms, presence of a hiatal hernia, manometric and 24 hour pH-monitoring data, duration of operation, incidence of complications and length of hospital stay.ResultsElderly patients more often had atypical symptoms of GERD and at manometric evaluation had a higher rate of impaired esophageal peristalsis in comparison with younger patients. The duration of the operation was similar between the two groups. The incidence of intraoperative and postoperative complications was low and the difference was not statistically significant between the two groups. An excellent outcome was observed in 93.0% of young patients and in 88.9% of elderly patients (p = NS).ConclusionsLaparoscopic antireflux surgery is a safe and effective treatment for GERD even in elderly patients, warranting low morbidity and mortality rates and a significant improvement of symptoms comparable to younger patients.

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“…However, the number of the elderly was small in this study. The prevalence of esophageal dysfunction 3 and hiatal hernia 4 increases with age. Because GERD is strongly associated with both of these, 5 the prevalence of GERD might be expected to increase with age.…”

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confidence: 99%