The assessment of oesophagitis in hiatus hernia patients

Abstract

The incidence of oesophagitis has been determined in 108 patients with sliding hiatus hernias using endoscopic, histological, and radiological criteria. Particular consideration has been given to the relationship between inflammatory disease and clinical symptoms. All the patients were attending a thoracic surgical clinic and the spectrum of disease encountered was fairly severe; over half of the cases had established strictures when first seen. The incidence of oesophagitis based on endoscopic evidence was 76-9%. while inflammatory change was noted on biopsy in 56 2% and at barium swallow in 58-3% of the patients. Oesophagoscopy proved to be the most satisfactory method of assessment; biopsy specimens were either inadequate or correlated poorly with other criteria while barium swallow was of diagnostic value only in severe oesophagitis. The main symptoms were pain, heartburn with regurgitation, dysphagia, and bleeding. Dysphagia was common due to the preponderance of patients with strictures, while obvious bleeding was very uncommon. Endoscopic oesophagitis was found in 75% of the patients with specific retrosternal pain and in 600O, of those with heartburn and regurgitation. The inability to equate heartburn with oesophagitis is emphasized. The incidence of inflammatory change in patients with dysphagia was 8722% ; nearly all the cases in this group showed stricture formation.Gastro-oesophageal reflux occurs in most patients with symptomatic hiatus hernia and may produce an inflammatory reaction of varying severity in the lower oesophagus. There is no agreement, however, on the frequency with which this reaction occurs nor on the influence it may have on clinical symptoms. In the past, many of the symptoms in hiatus hernia patients have been loosely attributed to reflux oesophagitis without adequate objective evidence. This study was undertaken firstly to determine the incidence of

Oesophageal acid clearing: One factor in the production of reflux oesophagitis

“…It is also recognized that the severity of reflux symptoms, the ease with which reflux occurs, and the degree of oesophagitis are poorly correlated (Tuttle, Bettarello, and Grossman, 1960;Siegel and Hendrix, 1963;Ward, Wright, and Collis, 1970;Woodward, 1970) factors governing their relationships are not understood. Secondary peristalsis induced by a surge of refluxed gastric contents has been considered as a protective mechanism emptying the oesophageal lumen of irritant juices (Creamer, 1955;Nagler and Spiro, 1961).…”

Late results of oesophageal and oesophagogastric resection in the treatment of oesophageal cancer

“…It was not felt justifiable to oesophagoscope the ather asymptomatic patients and absence of oesophagitis is based on subjective evidence alone. Previous experience with hiatus hernia patients, however, has indicated that oesophagitis is nearly always associated with clear-cut symptoms (Ward, Wright, and Collis, 1970).…”

Measurement of gastrow-oesophageal acid reflux: Its significance in hiatus hernia

“…Similar findings were noted by Woodward (1970), except that he found a poor correlation between prolonged reflux and severity of symptoms. A lack of correlation also between symptoms and oesophagoscopic appearances has previously been shown (Bernstein and Baker, 1958;Tuttle et al, 1960;Siege1 and Hendrix, 1963;Skinner, 1966;Ward et al, 1970). However, appreciable histological oesophagitis may be present without naked eye evidence (Goldberg et af., 1969).…”