Alimentary TractIncreased frequency of transient lower esophageal sphincter relaxation induced by gastric distention in reflux patients with hiatal hernia☆,☆☆
Section snippets
Materials and methods
Intraluminal pressures from within the esophagus, EGJ, and stomach, along with distal esophageal pH, were recorded during gastric air distention in healthy subjects and in patients with GERD who had varying degrees of hiatal hernia. The protocol was approved by the Northwestern University Institutional Review Board, and informed consent was obtained from all subjects.
Effect of intragastric air infusion on gastroesophageal acid reflux
The number of acid reflux events and the corresponding esophageal acid exposure times among the 3 groups are shown in Table 1.
Empty Cell No. of acid reflux events % Time with pH <4 Empty Cell Baseline Air infusion Baseline Air infusion Normal controls 0 (0–2) 4 (1.8–4.3)a 0 (0–5.6) 5.4 (3.1–10.4)a Nonhernia patients 0 (0–3) 6 (6.4–10.6)a,b 0 (0–4.9) 14.6 (5.6–16.6)a,b Hernia patients 1 (0–7) 12.8 (6.5–26.3)a,b,c 1.8 (0–5.8) 22.7 (14–24.8)a,b aP < 0.05
Discussion
Many clinical studies have strongly argued for more than a chance association between GERD and hiatal hernia.1, 2, 3, 4, 5 On the other hand, physiological studies analyzing the mechanism by which gastroesophageal reflux events occur have identified LES hypotension and especially tLESR as the dominant mechanisms of reflux.10, 11, 12 Thus, the physiological relevance of the anatomic aberrations of the EGJ associated with hiatal hernia remains incompletely defined. The major finding of this study
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Address requests for reprints to: Peter J. Kahrilas, M.D., Division of Gastroenterology and Hepatology, Department of Medicine, Northwestern University Medical School, Searle Building, 10th Floor, Suite 541, 303 East Chicago Avenue, Chicago, Illinois 60611. e-mail: [email protected]; fax: (312) 908-6192.
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Supported by grant RO1 DC00646 from the Public Health Service (to P.J.K.).