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 doublepeak (hernia) to a single...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 doublepeak (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.展开更多
In healthy subjects, the rate of acid reflux during transient lower esophageal sphincter relaxations (TLESRs) is more frequent at the proximal margin of the L ES. In this study, we investigated the hypothesis that the...In healthy subjects, the rate of acid reflux during transient lower esophageal sphincter relaxations (TLESRs) is more frequent at the proximal margin of the L ES. In this study, we investigated the hypothesis that the rate of acid reflux a t the proximal margin of LES during TLESRs is similar in reflux disease to that in healthy subjects. Concurrent esophageal manometry and pH monitoring were perf ormed in the sitting position for 3 hr after a standard meal in 10 patients with reflux disease and 10 agematched healthy controls. The rate of TLESRs in patien ts with reflux disease (5.0/hr [3.3-6.7]; median [interquartile range])-was si milar to that of controls (4.5/hr [3.7-5.7]). The incidence of acid reflux 7 cm above the LES during TLESRs in patients (48.1%[27.2-71.4%])was significantly higher than that in controls (10.9%[0.0-18.8%]) but there was no difference 2 cm above the LES (75.0 [69.2-87.5] vs. 74.3 [55.5-90.0%]). The rate of TLES Rs and the incidence of acid reflux during TLESRs are not increased in reflux disease. These findings, therefore, indicat e that reflux disease is not a disorder of TLESRs and relates more to the proxim al extent of the refluxate.展开更多
文摘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 doublepeak (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.
文摘In healthy subjects, the rate of acid reflux during transient lower esophageal sphincter relaxations (TLESRs) is more frequent at the proximal margin of the L ES. In this study, we investigated the hypothesis that the rate of acid reflux a t the proximal margin of LES during TLESRs is similar in reflux disease to that in healthy subjects. Concurrent esophageal manometry and pH monitoring were perf ormed in the sitting position for 3 hr after a standard meal in 10 patients with reflux disease and 10 agematched healthy controls. The rate of TLESRs in patien ts with reflux disease (5.0/hr [3.3-6.7]; median [interquartile range])-was si milar to that of controls (4.5/hr [3.7-5.7]). The incidence of acid reflux 7 cm above the LES during TLESRs in patients (48.1%[27.2-71.4%])was significantly higher than that in controls (10.9%[0.0-18.8%]) but there was no difference 2 cm above the LES (75.0 [69.2-87.5] vs. 74.3 [55.5-90.0%]). The rate of TLES Rs and the incidence of acid reflux during TLESRs are not increased in reflux disease. These findings, therefore, indicat e that reflux disease is not a disorder of TLESRs and relates more to the proxim al extent of the refluxate.
