TEMAS LIBRES
Cirugía General Cirugía esofagogastroduodenal
TITULO: GASTROESOPHAGEAL REFLUX DISEASE: CONSEQUENCES OF THE PRESENCE AND SIZE OF A HIATAL HERNIA
AUTORES: FRANCISCO SCHLOTTMANN, MARTIN GALVARINI, RUDOLF BUXHOEVEDEN, MARCO G. PATTI
Nº DE REFERENCIA 14407
TIPO PRESENTACION: Temas Libres
CATEGORIA: Cirugía General
SUBCATEGORIA: Cirugía esofagogastroduodenal
RESUMEN DE LA PRESENTACION:
ANTECEDENTES: A hiatal hernia (HH) is a frequent finding in patients with gastroesophageal reflux disease (GERD). Its presence alters the anatomic relationship between the lower esophageal sphincter (LES) and the diaphragmatic crus, erasing their synergistic action and therefore eliminating a key component of the antireflux mechanism.
OBJETIVO: The aim of this study was to determine how the presence and size of a HH affect the esophageal function, the reflux profile and the degree of mucosal injury
DISEÑO: Retrospective analysis of a prospectively collected database
MATERIAL Y METODO: A consecutive series of patients with GERD diagnosed by 24-hour pH monitoring were included. Based on the presence and size of HH on barium swallow, patients were divided into the following groups: no HH, HH < 3 cm, HH 3-5 cm and HH > 5 cm. Clinical presentation, esophageal manometry, pH monitoring and endoscopy findings were analyzed and compared between the groups.
RESULTADOS: A total of 175 patients were included: 43 with no HH, 86 with HH < 3 cm, 34 with HH 3-5 cm, and 12 with HH > 5 cm. Patients with larger HH had more frequent episodes of coughing and wheezing associated with episodes of reflux. Esophageal manometry showed that the increasing size of the HH was associated with decreasing pressure of the LES and weaker peristalsis. Ambulatory pH monitoring showed that patients with larger HH had more acid reflux, in both the distal and proximal esophagus. Endoscopy showed that patients with larger HH had more severe esophagitis. Fifty percent of patients with HH > 5.0 cm had Barrett’s esophagus.
CONCLUSIONES: In patients with proven GERD, presence and size of HH affect the clinical presentation, the esophageal function, the amount of acid exposure, and the degree of mucosal injury. These findings should guide gastroenterologists and surgeons in choosing the appropriate therapy in patients with GERD and large HH