| Unique features of esophagogastric junction pressure topography in hiatus hernia patients with dysphagia. | |
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MedLine Citation:
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PMID: 19744454 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Our aim was to assess pressure dynamics within the esophagogastric junction (EGJ) in sliding hiatus hernia (HH) during normal peristalsis and to compare the pressure profiles of HH patients with gastroesophageal reflux disease (GERD) symptoms (HH-GERD) to HH patients with dysphagia (HH-dysphagia). METHODS: High-resolution manometry studies in 230 consecutive patients and 68 controls were reviewed. HH patients were defined by a >or=1.5 cm separation between the lower esophageal sphincter (LES) and crural diaphragm (CD) on pressure topography plots. The HH population was further culled to eliminate those patients with motor disorders or stricture. The study groups were composed of 18 HH patients with only reflux symptoms and 10 HH patients with only dysphagia. Analysis of the pressure dynamics within the EGJ was performed at rest and after swallowing to independently quantify the LES and CD contributions to residual EGJ pressure, as well as the magnitude and genesis of distal esophageal intrabolus pressure (IBP). Differences among study groups were analyzed with analysis of variance. RESULTS: After swallows, HH-dysphagia patients had greater residual CD pressure (9 mmHg; standard deviation [SD], 4) and IBP pressure (19 mmHg; SD, 4) compared to HH-GERD patients (5 mmHg; SD, 2; and 12 mmHg; SD, 2, respectively; P<.001) or normal subjects (NA; 11 mmHg; SD, 3; P<.001). CONCLUSION: Sliding HH alters the pressure dynamics through the EGJ and can lead to a functional obstruction. Patients with HH and dysphagia have greater pressures through the CD compared to HH patients with GERD symptoms, supporting the hypothesis that sliding HH in and of itself may be responsible for dysphagia. |
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Authors:
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John E Pandolfino; Monika A Kwiatek; Kim Ho; John R Scherer; Peter J Kahrilas |
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Publication Detail:
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Type: Comparative Study; Journal Article; Research Support, N.I.H., Extramural Date: 2009-07-18 |
Journal Detail:
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Title: Surgery Volume: 147 ISSN: 1532-7361 ISO Abbreviation: Surgery Publication Date: 2010 Jan |
Date Detail:
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Created Date: 2010-01-19 Completed Date: 2010-02-12 Revised Date: 2010-12-03 |
Medline Journal Info:
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Nlm Unique ID: 0417347 Medline TA: Surgery Country: United States |
Other Details:
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Languages: eng Pagination: 57-64 Citation Subset: AIM; IM |
Copyright Information:
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Copyright (c) 2010 Mosby, Inc. All rights reserved. |
Affiliation:
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Department of Medicine, Division of Gastroenterology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA. j-pandolfino@northwestern.edu |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adult Aged Aged, 80 and over Deglutition Deglutition Disorders / complications, physiopathology* Esophagogastric Junction / physiopathology* Female Hernia, Hiatal / complications, physiopathology* Humans Male Middle Aged Pressure Retrospective Studies Young Adult |
| Grant Support | |
ID/Acronym/Agency:
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R01 DC000646-09/DC/NIDCD NIH HHS; R01 DC00646/DC/NIDCD NIH HHS |
| Comments/Corrections | |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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