E S Xenos1. 1. Department of Surgery, Lincoln County Memorial Center, 1000E Cherry Street, Troy, MO 63379, USA. lxenos@yahoo.com
Abstract
BACKGROUND: The pathogenesis of gastroesophageal reflux disease (GERD) is multifactorial. This study evaluates the relationship between esophageal exposure to acid, the presence or absence of a hiatal hernia, and manometric indicators of esophageal motility. METHODS: A total of 51 patients with foregut symptoms were evaluated with upper gastrointestinal series or endoscopy, 24-h pH testing, and esophageal manometry. The DeMeester score was used to distinguish patients with physiologic reflux (DeMeester score <14.72) patients with pathologic reflux (DeMeester score >14.72). RESULTS: Patients with physiologic reflux had fewer hypotensive contractions and a smaller percentage of uncoordinated and hypotensive contractions combined, as compared to patients with pathologic reflux. The amplitude of distal esophageal contractions was greater in patients with physiologic reflux. Also, patients with a hiatal hernia had a higher incidence of pathologic reflux, regardless of the lower esophageal sphincter pressure. CONCLUSION: Patients with pathologic reflux have abnormal acid exposure associated with pump failure of the esophagus and/or a mechanical defect of the cardia associated with a hiatal hernia.
BACKGROUND: The pathogenesis of gastroesophageal reflux disease (GERD) is multifactorial. This study evaluates the relationship between esophageal exposure to acid, the presence or absence of a hiatal hernia, and manometric indicators of esophageal motility. METHODS: A total of 51 patients with foregut symptoms were evaluated with upper gastrointestinal series or endoscopy, 24-h pH testing, and esophageal manometry. The DeMeester score was used to distinguish patients with physiologic reflux (DeMeester score <14.72) patients with pathologic reflux (DeMeester score >14.72). RESULTS:Patients with physiologic reflux had fewer hypotensive contractions and a smaller percentage of uncoordinated and hypotensive contractions combined, as compared to patients with pathologic reflux. The amplitude of distal esophageal contractions was greater in patients with physiologic reflux. Also, patients with a hiatal hernia had a higher incidence of pathologic reflux, regardless of the lower esophageal sphincter pressure. CONCLUSION:Patients with pathologic reflux have abnormal acid exposure associated with pump failure of the esophagus and/or a mechanical defect of the cardia associated with a hiatal hernia.
Authors: M Fein; M P Ritter; T R DeMeester; S Oberg; J H Peters; J A Hagen; C G Bremner Journal: J Gastrointest Surg Date: 1999 Jul-Aug Impact factor: 3.452
Authors: Puya Gharahkhani; Rebecca C Fitzgerald; Thomas L Vaughan; Claire Palles; Ines Gockel; Ian Tomlinson; Matthew F Buas; Andrea May; Christian Gerges; Mario Anders; Jessica Becker; Nicole Kreuser; Tania Noder; Marino Venerito; Lothar Veits; Thomas Schmidt; Hendrik Manner; Claudia Schmidt; Timo Hess; Anne C Böhmer; Jakob R Izbicki; Arnulf H Hölscher; Hauke Lang; Dietmar Lorenz; Brigitte Schumacher; Andreas Hackelsberger; Rupert Mayershofer; Oliver Pech; Yogesh Vashist; Katja Ott; Michael Vieth; Josef Weismüller; Markus M Nöthen; Stephen Attwood; Hugh Barr; Laura Chegwidden; John de Caestecker; Rebecca Harrison; Sharon B Love; David MacDonald; Paul Moayyedi; Hans Prenen; R G Peter Watson; Prasad G Iyer; Lesley A Anderson; Leslie Bernstein; Wong-Ho Chow; Laura J Hardie; Jesper Lagergren; Geoffrey Liu; Harvey A Risch; Anna H Wu; Weimin Ye; Nigel C Bird; Nicholas J Shaheen; Marilie D Gammon; Douglas A Corley; Carlos Caldas; Susanne Moebus; Michael Knapp; Wilbert H M Peters; Horst Neuhaus; Thomas Rösch; Christian Ell; Stuart MacGregor; Paul Pharoah; David C Whiteman; Janusz Jankowski; Johannes Schumacher Journal: Lancet Oncol Date: 2016-08-12 Impact factor: 41.316