1998 Abstract: THE ROLE OF THE LOWER ESOPHAGEAL SPHINCTER AND HIATAL HERNIA IN THE PATHOGENESIS OF GASTRO-ESOPHAGEAL REFLUX DISEASE. M. Fein, M.P. Ritter, T.R. DeMeester, J.H. Peters, S. Öberg, J.A. Hagen, C.G. Bremner. Univ. of Southern California, Dept. of Surgery, Los Angeles, CA. 5
Abstracts 1998 Digestive Disease Week
#4479
THE ROLE OF THE LOWER ESOPHAGEAL SPHINCTER AND HIATAL HERNIA IN THE PATHOGENESIS OF GASTRO-ESOPHAGEAL REFLUX DISEASE. M. Fein, M.P. Ritter, T.R. DeMeester, J.H. Peters, S. Öberg, J.A. Hagen, C.G. Bremner. Univ. of Southern California, Dept. of Surgery, Los Angeles, CA.
Background: The relative importance of the lower esophageal sphincter (LES) and the presence of hiatal hernia in the pathogenesis of gastroesophageal reflux disease is controversial. Aim: To analyze the effects of LES characteristics and hiatal hernia on esophageal acid exposure. Methods: Three hundred seventy five consecutive patients with foregut symptoms and no previous foregut surgery underwent upper endoscopy, stationary manometry and 24h esophageal pH monitoring. On endoscopy the gastroesophageal junction was defined by the proximal extent of the gastric rugal folds. Hiatal hernia was diagnosed when the distance between the crural diaphragm and the gastroesophageal junction was _ 2cm. Esophageal mucosal injury was defined in the presence of erosive esophagitis or Barrett's esophagus. The prevalence of increased esophageal acid exposure (composite acid score > 14.7) was related to the presence of hiatal hernia and a structurally defective LES (pressure and /or overall length and/or abdominal length < 5th percentile in 50 normal volunteers). The prevalence of esophageal mucosal injury was related to hernia length.
Results: The prevalence of increased esophageal acid exposure was highest when both defective LES (def LES) and hiatal hernia (HH) were present (figure). It was similar in patients who had either defective LES or hiatal hernia. There was no difference in the prevalence of mucosal injury in patients with small (2-3cm), medium (4-5cm) or large hernias (>5cm). Conclusion: A structurally defective LES is as important as hiatal hernia in the pathogenesis of gastroesophageal reflux disease. There is an additive effect when both are present.
Copyright 1996 - 1998, SSAT, Inc. Revised 29 June 1998.
