| Intermittent spatial separation of diaphragm and lower esophageal sphincter favors acidic and weakly acidic reflux. | |
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MedLine Citation:
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PMID: 16472589 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND & AIMS: In small hiatal hernias, the size of the hernia is variable. Intermittent complete reduction can be observed with high-resolution manometry as a transition from a double-peak (hernia) to a single-peak (reduced) high-pressure zone. The aim of this study was to investigate whether intermittent separation of the diaphragm and lower esophageal sphincter (LES) favors the occurrence of gastroesophageal reflux. METHODS: In 16 patients with a small hiatal hernia (3 cm), prolonged high-resolution manometry was performed. Acid and weakly acidic reflux episodes were detected with pH-impedance monitoring. RESULTS: The single pressure peak profile (reduced hernia) was present for 814 minutes (56.5% of total time), and the double peak profile (unreduced hernia) was present for 626 minutes (43.5% of total time). In all patients, both pressure profiles were observed. The transition rate between the 2 profiles was 7.5 +/- 0.9 per hour. More reflux occurred when the LES and diaphragm were separated versus the reduced hernia state (23.1 +/- 5.1 vs 12.2 +/- 2.4 episodes per hour, respectively; P < .05). The proportions of acidic reflux episodes during the single and double pressure peaks were similar (70% and 67%, respectively). In the two-pressure-zone state, there was an increase in all reflux mechanisms except transient LES relaxation. CONCLUSIONS: In patients with a small hiatal hernia, intermittent reduction of the hernia occurs frequently. Spatial separation of the diaphragm and LES in the nonreduced state results in a 2-fold increase in acidic and weakly acidic reflux due to mechanisms other than transient LES relaxation. |
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Authors:
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Albert J Bredenoord; Bas L A M Weusten; Robin Timmer; André J P M Smout |
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Publication Detail:
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Type: Journal Article; Research Support, Non-U.S. Gov't |
Journal Detail:
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Title: Gastroenterology Volume: 130 ISSN: 0016-5085 ISO Abbreviation: Gastroenterology Publication Date: 2006 Feb |
Date Detail:
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Created Date: 2006-02-13 Completed Date: 2006-04-13 Revised Date: 2006-11-15 |
Medline Journal Info:
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Nlm Unique ID: 0374630 Medline TA: Gastroenterology Country: United States |
Other Details:
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Languages: eng Pagination: 334-40 Citation Subset: AIM; IM |
Affiliation:
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Department of Gastroenterology, Saint Antonius Hospital, Nieuwegein, The Netherlands. a.bredenoord@antonius.net |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Diaphragm
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anatomy & histology*,
radiography Esophagus / anatomy & histology*, radiography Gastric Acid / secretion Gastroesophageal Reflux / classification, etiology, physiopathology*, radiography Hernia, Hiatal / complications Humans Hydrogen-Ion Concentration Jejunum / anatomy & histology Pressure Reproducibility of Results |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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