Zhi-Tong Li1, Feng Ji1, Xin-Wei Han1, Lin-Xia Gu2, Li Wang1, Yong-Qiang Yue1, Zhong-Gao Wang1. 1. Department of Interventional Radiology and GERD, The First Affiliated Hospital, Zhengzhou University, Zhengzhou, Henan Province, People's Republic of China. 2. Department of Mechanical and Materials Engineering, University of Nebraska Lincoln, Lincoln, Nebraska.
Abstract
BACKGROUND: To determine the correlation between asthma and hiatal hernia (HH) in patients with gastroesophageal reflux disease (GERD)-related asthma requiring laparoscopic anti-reflux surgery. METHODS: One hundred and thirty-six GERD patients with medically refractory asthma with (80 patients) or without HH (56 patients) were enrolled. Gastroesophageal reflux disease was assessed by endoscopy, esophageal manometry, reflux monitoring and symptom questionnaires, and treated with laparoscopic Nissen fundoplication (LNF) or LNF with concomitant hiatal hernia repair (LNF-HHR). The outcome measures included patients' satisfaction and drug independence. RESULTS: The patients with HH had lower esophageal sphincters (P = .005) and higher DeMeester scores (P = .014) than those without HH. After an average follow-up of 24 months, symptom scores were significantly decreased from the preoperative values (P < .05). Compared to LNF, LNF-HHR showed a better improvement in both esophageal and asthmatic symptoms (P < .0001 and P = .016, respectively). CONCLUSIONS: The patients with GERD with asthma have a high prevalence of HH. The presence of HH maybe correlated with asthma and severe GERD. Actively treating HH not only improved reflux, but also controlled asthma symptoms.
BACKGROUND: To determine the correlation between asthma and hiatal hernia (HH) in patients with gastroesophageal reflux disease (GERD)-related asthma requiring laparoscopic anti-reflux surgery. METHODS: One hundred and thirty-six GERDpatients with medically refractory asthma with (80 patients) or without HH (56 patients) were enrolled. Gastroesophageal reflux disease was assessed by endoscopy, esophageal manometry, reflux monitoring and symptom questionnaires, and treated with laparoscopic Nissen fundoplication (LNF) or LNF with concomitant hiatal hernia repair (LNF-HHR). The outcome measures included patients' satisfaction and drug independence. RESULTS: The patients with HH had lower esophageal sphincters (P = .005) and higher DeMeester scores (P = .014) than those without HH. After an average follow-up of 24 months, symptom scores were significantly decreased from the preoperative values (P < .05). Compared to LNF, LNF-HHR showed a better improvement in both esophageal and asthmatic symptoms (P < .0001 and P = .016, respectively). CONCLUSIONS: The patients with GERD with asthma have a high prevalence of HH. The presence of HH maybe correlated with asthma and severe GERD. Actively treating HH not only improved reflux, but also controlled asthma symptoms.