Does Hiatus Hernia Affect Competence of the Gastroesophageal Sphincter?

Cohen, Sidney; Harris, Lauran D.

doi:10.1056/nejm197105132841902

Cited by 369 publications

(122 citation statements)

References 5 publications

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“…The zone is capable of responding to a challenge of increased abdominal pressure by an incremental contraction or resistance to; stretch, which is greater than the challenge. This evidence suggests that the incremental response of the high pressure zone previously reported by Lind et al (1966) and Cohen and Harris (1971) is mediated by the hiatus and not by the sphincter. We have suggested this previously on the basis of other evidence (Dilawari et al, 1974 on to her right side, but did not reflux barium while straight-leg-raising, when the hiatus was seen to be contracted and to cut off the flow of barium across the hiatus.…”

Section: Radiographic Studiessupporting

confidence: 66%

“…After cardiomyotomy the sphincter component is likely to be absent or weakened, and the supposed contraction response of the sphincter to challenge (Lind et al, 1966;Cohen and Harris, 1971) is likely to be prevented. The possibility that some circular fibres remain uncut and act effectively as a sphincter, without causing dysphagia, can be investigated by examining any patient who has the capacity to herniate the remains of the sphincter together with a loculus of the stomach through the hiatus.…”

Section: Radiographic Studiesmentioning

confidence: 99%

“…Paired values for each of at least three pull-throughs are plotted against each other after the manner of Cohen and Harris (1971) in fig 3. In each patient the increment in the high pressure zone was greater than the increment in fundal pressure. The graph (fig 3) is remarkably similar to that published by Cohen and Harris (1971). If it can be assumed that the sphincter fibres were cut the high pressure zone shown by perfusion manometry must reflect the presence of a zone of increased resistance to stretch caused by the hiatus.…”

Section: Radiographic Studiesmentioning

confidence: 99%

See 2 more Smart Citations

The anti-reflux mechanism after cardiomyotomy.

Lobello¹,

Edwards²,

Gummer³

et al. 1978

Thorax

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M (1978). Thorax, 33,[569][570][571][572][573]. The anti-reflux mechanism after cardiomyotomy. Only 18 of 83 patients who had had a cardiomyotomy for achalasia could be induced to reflux barium. Mucosal herniation through the myotomy was shown in most by radiography. Perfusion manometry showed a higher pressure zone in the oesophagogastric junction region in 22 of 24 patients studied. This high pressure zone responded to an increment in abdominal pressure by a greater increment. The same response was seen in a patient with a small hiatal hernia and a myotomy. We conclude that the persisting high pressure zone seen by perfusion manometry is likely to be caused by the hiatus, and that the hiatus rather than the sphincter is likely to be responsible for the incremental response of the high pressure zone to increased abdominal pressure. The anti-reflux mechanism after cardiomyotomy is more likely to be the hiatal mechanism than persisting sphincter fibres.A large proportion of our patients who have had a cardiomyotomy for achalasia do not have symptoms of reflux, and we are unable to show the capacity to reflux barium by radiology. Ellis and Cole (1965) made a similar observation and attributed the persistence of an anti-reflux mechanism to the hiatus. Atkinson (1959) and Ellis et al (1967) recorded a high pressure zone at the oesophagogastric junction in some subjects after cardiomyotomy, concluding that this high pressure zone was caused by persisting sphincter fibres and was the explanation of the lack of evidence of reflux.The technique of myotomy used on our patients makes it unlikely that sphincter fibres persist and our purpose was to investigate the anti-reflux mechanism after such a cardiomyotomy. The hypotheses to be tested were (1) that an anti-reflux mechanism could be present in the total absence of any sphincter fibres and (2) that the oesophageal hiatus of the diaphragm was contributing to the high pressure zone.

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Section: Radiographic Studiessupporting

confidence: 66%

Section: Radiographic Studiesmentioning

confidence: 99%

Section: Radiographic Studiesmentioning

confidence: 99%

See 1 more Smart Citation

The anti-reflux mechanism after cardiomyotomy.

Lobello¹,

Edwards²,

Gummer³

et al. 1978

Thorax

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“…6 Our results show that glycopyrrolate decreases the barrier pressure (lower oesophageal sphincter pressure minus gastric pressure). Atropine and hyoscine have previously, been shown to decrease lower oesophageal sphincter tone, TM whereas the effects of glycopyrrolate in this respect have not been previously reported.…”

Section: Discussionmentioning

confidence: 55%

The effect of glycopyrrolate (Robinul) on the lower oesophageal sphincter

Brock‐Utne¹,

Rubin²,

Welman³

et al. 1978

Canad. Anaesth. Soc. J.

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“…As a result, some authors believed that it was necessary to excise HH to cure GER disease. Another opinion was that the existence of HH did not affect esophageal sphincter competence [7][8][9][10] . The third opinion was that HH might play only a partial role in the development of esophagitis, that is, the absence of HH could exclude more severe forms of reflux esophagitis [11][12][13][14] .…”

Section: Introductionmentioning

confidence: 99%

Study of the influence of hiatus hernia on gastroesophageal reflux

Zhu¹

2011

WJG

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AIM:To explore whether the presence of a sliding hiatus hernia influences gastroesophageal reflux. METHODS:Endoscopy and 24 h pH monitoring were performed for 197 outpatients with gastroesophageal reflux symptoms. RESULTS:Of the 1�7 patients with symptoms of gastroesophageal reflux, patients with hiatus hernia accounted for 36%. The incidence of esophagitis in patients with hiatus hernia was signi��cantly higher than that in patients without hiatus hernia. The results of 24 h pH monitoring showed that 84 patients had physiological reflux, 37 had pathological reflux without esophagitis, 64 had reflux esophagitis and 12 had physiological reflux concomitant with esophagitis. All the patients with hiatus hernia had a longer percentage time with supine reflux and a higher fre�uency of episodes lasting over 5 min at night compared to those without hiatus hernia. The incidence of combined daytime and nocturnal reflux in patients with hiatus hernia was signi��cantly higher than that in patients without hiatus hernia. CONCLUSION:Pathological reflux and reflux esophagitis in some patients with symptoms of gastroesophageal reflux represent two different stages of gastroesophageal reflux disease. Pathological reflux is the first stage, in which the lower esophageal sphincter is incompetent but the esophageal mucosal resistance effectively prevents regurgitated acid from damaging the esophageal mucosa. Reflux esophagitis represents the second stage, in which the aggression of the regurgitated acid is so strong that the esophageal mucosa fails to resist it and the epithelium of the esophagus is damaged. Patients with hiatus hernia have a high incidence of combined daytime and nocturnal reflux, with the latter being responsible for esophagitis.

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Does Hiatus Hernia Affect Competence of the Gastroesophageal Sphincter?

Cited by 369 publications

References 5 publications

The anti-reflux mechanism after cardiomyotomy.

The anti-reflux mechanism after cardiomyotomy.

The effect of glycopyrrolate (Robinul) on the lower oesophageal sphincter

Study of the influence of hiatus hernia on gastroesophageal reflux

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