Using conventional manometry, the majority of patients with massive paraesophageal hiatal hernias will present with a hypotensive lower esophageal sphincter (LES) and hypotensive peristalsis in the distal esophageal body; however, there are no reports on the use of high resolution manometry (HRM) in patients with an intrathoracic stomach.
Aim: This study aims to evaluate the manometric pattern found in patients with an intrathoracic stomach using HRM.
Methods: We reviewed 10 patients (9 females, median age 62 years) who were found to have an intrathoracic stomach, as defined by a large paraesophageal hernia with more than 50% of the stomach in the mediastinum on barium esophagography. Nine patients had a type III hernia and one patient had a type IV hernia. All patients underwent HRM in our laboratory.
Results: Results are expressed in the table below.The LES was hypotensive (<6mmHg) in 1 (10%) patient and hypertensive (>28mmHg) in 2 (20%) patients. Distal esophageal amplitude was hypotensive in 1 (10%) patient. Proximal esophageal amplitude was hypotensive (<30mmHg) in 3 (30%) patients.
Conclusion: Most patients with an intrathoracic stomach have normal manometric findings on HRM.
| Median | Range | |
| LES length (cm) | 2.4 | 2.3-3.3 |
| LES midrespiratory pressure (mmHg) | 19.5 | 1.6-45.9 |
| Distal esophageal amplitude (mmHg) | 70.9 | 26.2-162.7 |
| Proximal esophageal amplitude (mmHg) | 35.9 | 23.9-65.7 |
| Peristaltic waves (%) | 100 | 80-100 |
| Upper sphincter pressure (mmHg) | 44.1 | 21.6-105.6 |
| Esophageal length (cm) | 18.5 | 15.5-22.7 |
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