Maximal acid output and oesophagitis in hiatus hernia

Abstract

It has been suggested (Casten, Bernhang, Nach, and Spinzia, 1963) that patients with symptomatic sliding hiatus hernia have a higher acid output than the normal patient, but this has recently been disputed by Williams, Lawrie, and Forrest (1967). These latter workers found that there is no significant increase in maximal acid output in patients with sliding hiatus hernia. Aylwin (1953) demonstrated a correlation between the degree of oesophagitis in sliding hiatus hernia and the enzyme activity of juices bathing the oesophagus at night, and suggested that this was the chief factor in the production of oesophagitis. In this study patients with hiatus hernia were investigated to see if there was any correlation between the degree of oesophagitis and the maximal acid output. The maximal acid output in patients with hiatus hernia was found not to differ significantly from normal, and the degree of oesophagitis in the patients with oesophageal reflux was not closely related to the maximal acid output. MATERIALFifty-seven patients admitted for surgical repair of symptomatic hiatus hernia were studied. All patients had pre-operative barium studies to detect gastrooesophageal reflux, oesophageal stricture, and gastric or duodenal ulceration. Oesophagoscopy was also carried out in every case to determine the presence and degree of oesophagitis.Of the 57 patients, 21 were men and 36 were women, with an age range from 33 to 77 years. Fifty patients had sliding hiatus herniae; seven of these had strictures and one had a Schatzki's ring. Six patients had paraoesophageal herniae and one patient had oesophageal reflux without demonstrable hiatus hernia.In the series seven patients were known to have had duodenal ulceration, six of whom had sliding hiatus herniae and one of whom had a paraoesophageal hernia. In all patients a thoraco-abdominal approach was used for repair of the hiatus hernia, and no evidence of duodenal ulceration was found in any other patient on direct examination of the duodenum.

The association of oesophagitis with disease in the stomach and duodenum

“…Previous reports (Williams, Lawrie and Forrest, 1967;Squire, Glick and Benn, 1968;Stol, Murphy and Collis, 1974) involving a small number of selected cases have cast doubt on the role of gastric acid hypersecretion in oesophagitis.…”

The pattern of bile salt reflux and acid secretion in sliding hiatal hernia

“…, 1955;Winkelstein, 1957;Tuttle et al, 1960;Casten et al, 1963;Burge and Amery, 1973). Evidence has been presented that other agents may be involved (Marchand, 1955;Palmer, 1960;Cox, 1961;Squire et al, 1968;Collis, 1970;Gillison et al, 1971;Henderson et al, 1973;Stol et al, 1974). Bile, among…”

Hiatus Hernia and Œsophageal Reflux

“…He documented high acid secretion in many of his patients, but many had concurrent duodenal ulcers. When ulcer patients are excluded, others have reported that stimulated acid secretion is normal in patients with hiatus hernia (Williams et al 1967, Squire et al 1968). Our own data indicate no difference between normal subjects and those with hiatus hernia in terms of maximal acid output stimulated by pentagastrin or histamine.…”