RT Journal
A1 Roman S, Kahrilas PJ, Kia L, Luger D, Soper N, Pandolfino JE
T1 EFfects of large hiatal hernias on esophageal peristalsis
JF Archives of Surgery
JO Archives of Surgery
YR 2012
FD April 1
VO 147
IS 4
SP 352
OP 357
DO 10.1001/archsurg.2012.17
UL http://dx.doi.org/10.1001/archsurg.2012.17
AB Hypothesis 
                  Anatomic changes induced by large hiatal hernia may alter esophageal pressure topography measurements made during high-resolution manometry.Design 
                  Retrospective study.Setting 
                  Single-institution tertiary hospital.Patients 
                  Ninety patients with large (>5 cm) hiatal hernias on endoscopy were compared with a control group of 46 patients without hernia selected from the same database of 2000 consecutive clinical high-resolution manometry studies.Intervention 
                  High-resolution manometry with at least 7 evaluable swallows for analysis.Main Outcomes Measures 
                  Esophageal pressure topography was analyzed for lower esophageal sphincter pressure, distal contractile integral, contraction amplitude, contractile front velocity, and distal latency time. Esophageal length was measured on esophageal pressure topography from the distal border of the upper esophageal sphincter to the proximal border of the lower esophageal sphincter. Esophageal pressure topography diagnosis was based on the Chicago Classification.Results 
                  The manometry catheter was coiled in the hernia and did not traverse the diaphragm in 44 patients (49%) with large hernia. Patients with large hernias had lower average lower esophageal sphincter pressures, a lower distal contractile integral, slower contractile front velocity, and shorter distal latency time than patients without hernia. They also exhibited a shorter mean esophageal length. However, the distribution of peristaltic abnormalities was not different in patients with and without large hernia.Conclusions 
                  Patients with large hernias had an alteration of esophageal pressure topography measurements and a shortened esophagus. However, the distribution of peristaltic disorders was unaffected by the presence of hernia.