1985 Volume 52 Issue 6 Pages 673-682
A survey was made on esophageal hiatal hernia in a series of 169 roentgenologically proven cases, with an investigation made into the pathophysiology an clinical implications of gastroesophageal reflux from the aspect of lower esophageal sphincte pressure (LESP).
The incidence of hiatal hernia was 0.91% in outpatients withdigestive syndrome who were treated in this Internal department ; it was most frequent in elderly women, its incidence increasing with advancing age. In 31.9% of the cases there was a concomitant esophagitis and all such cases developed subjective symptoms, notably beartburn, with 39.2% of them having a complication of ulcerative lesions.
Abnormal lordosis was present in 69.6% of the patients with esophageal hiatal hernia while complicating esophagitis tended to be frequent in the presence of abnormal lordosis. These facts suggest that abnormal lordosis is a etiologic factor of the greatest importance for esophageal hiatal hernia.
Esophageal manometry demonstrated a high pressure zone with two distinct peaks in the lower esophagus in 86.8% of hiatal hernia cases, with both of these peaks being lower than LESP of normal subjects.
There was no noticeable difference in LESP between cases with complicating esophagitis and those without it, although the former showed a less marked rise in LESP in response to pentagastrin or metoclopramide. The size of the esophageal hiatal hernia was found not to have any relation with the concurrence of esophagitis.
Endoscopic esophageal manometry, if performed under appropriate conditions, yeilds values approximate to measurements obtained by the conventional nonendoscopic method and would hence serve actual clinical purposes.
The endoscopic dye reflux test reflects LESP and provides a useful easy-to-use means of assessing gastroesophageal reflux.
