Hiatal hernia size affects lower esophageal sphincter function, esophageal acid exposure, and the degree of mucosal injury

Patti, Marco G.; Goldberg, Henry I.; Arcerito, Massimo; Bortolasi, Luca; Tong, Jenny; Way, Lawrence W.

doi:10.1016/s0002-9610(99)80096-8

Cited by 174 publications

(96 citation statements)

References 15 publications

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“…4 Today, emphasis is also placed on the role of mixed gastroesophageal reflux 5 and on the transdiaphragmatic pressure gradient 6 as both have important therapeutic implications.…”

Section: Pathophysiology Of Gerd and Its Importance In Patients With mentioning

confidence: 99%

The Intersection of GERD, Aspiration, and Lung Transplantation

Patti

Vela

Odell

et al. 2016

Journal of Laparoendoscopic & Advanced Surgical Techniques

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Lung transplantation is a radical but life-saving treatment option for patients with end-stage lung diseases, such as idiopathic pulmonary fibrosis (IPF) and scleroderma. In light of the proposed association and controversy linking gastroesophageal reflux disease (GERD) to IPF and lung transplant outcome, the American Gastroenterological Association convened during the DDW in Washington in May 2015 a multidisciplinary group of experts in the field of GERD and lung transplantation to make considerations about the care of these patients based on available data and subsequent expert panel discussion at this symposium. The following topics were discussed: (1) pathophysiology of GERD-induced pulmonary symptoms, (2) GERD evaluation before and after lung transplantation, (3) outcome of lung transplantation for IPF and scleroderma, and (4) role of laparoscopic fundoplication before or after lung transplantation.

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“…4 Today, emphasis is also placed on the role of mixed gastroesophageal reflux 5 and on the transdiaphragmatic pressure gradient 6 as both have important therapeutic implications.…”

Section: Pathophysiology Of Gerd and Its Importance In Patients With mentioning

confidence: 99%

The Intersection of GERD, Aspiration, and Lung Transplantation

Patti

Vela

Odell

et al. 2016

Journal of Laparoendoscopic & Advanced Surgical Techniques

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“…Oesophageal dysmotility, seen in some patients with GHH, is associated with a reduced ability to clear acid contents, however, the data allowing analysis of the relationship between HH and oesophageal dysmotility is inconsistent [25][26][27][28].…”

Section: Impairment Of Oesophageal Acid Clearancementioning

confidence: 99%

“…• Acid may be trapped in the HH during oesophageal clearance, refluxing into the oesophagus during Lower Oesophageal Sphincter (LOS) relaxation as the patient swallows [24,28,29].…”

Section: Impairment Of Oesophageal Acid Clearancementioning

confidence: 99%

“…The evidence for more significant GORD, when it is present in GHH is: endoscopically proven oesophagitis is more prevalent (Table 1); endoscopic grade of oesophagitis is higher [25]; larger HH are associated with higher number of reflux episodes lasting more than 5 minutes in 24-hour pH studies [28,29]; para-oesophageal hernias are associated with worse symptoms and endoscopic findings than fixed sliding HH [19].…”

Section: Gord and Hhmentioning

confidence: 99%

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Giant Hiatus Hernia and Association with Gastro-Oesophageal Reflux: A Review

Chan

2017

J Clin Gastroenterol Treat

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The term "giant hiatus hernia" has been variably defined, but most authors refer to at least 30% of the stomach, with or without other abdominal viscera, herniating through the oesophageal hiatus of the diaphragm into the mediastinum. This causes dysfunction of the lower oesophageal sphincter complex and can lead to obstructive symptoms, atypical extra-oesophageal symptoms as well as medically difficult to control reflux. When indicated, operative repair involves complete reduction of the hernia and the associated peritoneal sac, and partial hiatal closure in combination with an anti-reflux procedure. Surgery for giant hiatal hernias is complex, but can be performed with low morbidity and mortality with effective, long-term symptom resolution and improvement in health related quality of life.

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“…Poh et al [26] concluded that elder patients are always associated with decrease gastroesophageal motion with decreasing in the pressure of the upper sphincter of the esophagus, and increasing exposure to acids in esophagus. Also, Patti et al [27] detected that 60% of individuals presented with hiatal hernias older than 60 yrs in which oesophageal reflux and erosive oesophagitis were increased. In the current study smoking habit was more common in IPF patients (group I) than in non IPF patients (group II) but without statistical significance.…”

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confidence: 99%

Assessment of Bronchoalveolar Lavage Pepsin Level in Idiopathic Pulmonary Fibrosis

Said¹,

Alsowey²,

Ibraheem³

2017

Zagazig University Medical Journal

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Background: Idiopathic pulmonary fibrosis (IPF) is defined as a specific form of chronic, progressive fibrosing interstitial pneumonia of unknown cause.Recently, there is increasing evidence supporting a relationship between gastroesophageal reflux, microaspiration, and IPF, since the diagnostic gold-standard for microaspiration remains unknown. So, the aim of this study is to assess the presence of chronic microaspirates by bronchoalveolar lavage pepsin level in these patients. Patients and method: A case -control study was conducted at Chest Department and outpatient clinics Faculty of Medicine, Zagazig University hospitals in the period from (February 2013 till January 2016) on thirty patients with stable interstitial lung diseases (ILD).they were divided into two groups: 15 patients (group I) with stable idiopathic pulmonary fibrosis (IPF), another 15 patients (group II) stable ILD other than IPF. Both groups underwent pulmonary function tests (PFTs), Pulmonary HRCT and Bronchoscopy. Measurement of bronchoalveolar lavage pepsin level was done for all patients. Results: 80% of IPF patients complained from gastroesophageal reflux with a statistically significant decrease in PaO 2 , FEV 1 and FVC than in non IPF patients.Bronchoalveolar lavage pepsin level was (43.711.4ng/ml) in IPF group, which was significantly higher than non IPF group (32.710.5 ng/ml).Also total cell count in IPF patients were increased significantly including neutrophils, alveolar macrophages and red blood. Increased reticulation on HRCT for IPF patients group were associated with higher BAL pepsin levels (p <0.01). Regression coefficient revealed the most powerful predictor of IPF severity were; HRCT findings: reticulation score,honeycombing score[(Odds ratio(95%CI)=5.3 (1.9 to14.9), 7.8 (2.7 to 22.3)respectively],pepsin level[(Odds ratio(95%CI)=4.6 (1.9-11.4)],FEV1 and FVC[(Odds ratio(95%CI)=3.7 (1.6 to 8.9), 3.2 (1.4 to 7.5)respectively].while gastroesophageal reflux symptom [(Odds ratio(95%CI)=1.04(0.94-1.14)] was the least powerful predictor. Conclusion: Gastroesophageal reflux or microaspiration is common in patients with IPF, associated with elevated levels of pepsin in BAL fluid.

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Hiatal hernia size affects lower esophageal sphincter function, esophageal acid exposure, and the degree of mucosal injury

Cited by 174 publications

References 15 publications

The Intersection of GERD, Aspiration, and Lung Transplantation

The Intersection of GERD, Aspiration, and Lung Transplantation

Giant Hiatus Hernia and Association with Gastro-Oesophageal Reflux: A Review

Assessment of Bronchoalveolar Lavage Pepsin Level in Idiopathic Pulmonary Fibrosis

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