Thomas Franzén1, Lita Tibbling1. 1. Thomas Franzén, Lita Tibbling, Faculty of Health and Sciences, Linköping University, Department of Surgery, Vrinnevi Hospital Norrköping, SE-601 82 Norrköping, Sweden.
Abstract
AIM: To determine if the severity of gastroesophageal reflux disease is dependent on the size of a hiatus hernia. METHODS: Seventy-five patients with either a small (n = 25), medium (n = 25) or large (n = 25) hiatus hernia (assessed by high resolution esophageal manometry) were investigated using 24-h esophageal monitoring and a self-assessed symptom questionnaire. The questionnaire comprised the following items, each graded from 0 to 3 according to severity: heartburn; pharyngeal burning sensation; acid regurgitation; and chest pain. RESULTS: The percentage total reflux time was significantly longer in the group with hernia of 5 cm or more compared with the group with a hernia of < 3 cm (P < 0.002), and the group with a hernia of 3 to < 5 cm (P < 0.04). Pharyngeal burning sensation, heartburn and acid regurgitation were more common with large hernias than small hernias, but the frequency of chest pain was similar in all three hernia groups. CONCLUSION: Patients with a large hiatus hernia are more prone to have pathological gastroesophageal reflux and to have more acid symptoms than patients with a small hiatus hernia. However, it is unlikely that patients with an absence of acid symptoms will have pathological reflux regardless of hernia size.
AIM: To determine if the severity of gastroesophageal reflux disease is dependent on the size of a hiatus hernia. METHODS: Seventy-five patients with either a small (n = 25), medium (n = 25) or large (n = 25) hiatus hernia (assessed by high resolution esophageal manometry) were investigated using 24-h esophageal monitoring and a self-assessed symptom questionnaire. The questionnaire comprised the following items, each graded from 0 to 3 according to severity: heartburn; pharyngeal burning sensation; acid regurgitation; and chest pain. RESULTS: The percentage total reflux time was significantly longer in the group with hernia of 5 cm or more compared with the group with a hernia of < 3 cm (P < 0.002), and the group with a hernia of 3 to < 5 cm (P < 0.04). Pharyngeal burning sensation, heartburn and acid regurgitation were more common with large hernias than small hernias, but the frequency of chest pain was similar in all three hernia groups. CONCLUSION:Patients with a large hiatus hernia are more prone to have pathological gastroesophageal reflux and to have more acid symptoms than patients with a small hiatus hernia. However, it is unlikely that patients with an absence of acid symptoms will have pathological reflux regardless of hernia size.
Authors: Reginald V N Lord; Steven R DeMeester; Jeffrey H Peters; Jeffrey A Hagen; Dino Elyssnia; Corinne T Sheth; Tom R DeMeester Journal: J Gastrointest Surg Date: 2008-12-03 Impact factor: 3.452
Authors: Renato Salvador; Attila Dubecz; Marek Polomsky; Oliver Gellerson; Carolyn E Jones; Daniel P Raymond; Thomas J Watson; Jeffrey H Peters Journal: J Am Coll Surg Date: 2009-04-24 Impact factor: 6.113