Hiatal hernia is a common disease, which is always complicated with gastro-esophageal reflux. However, owing to restriction of diagnosis ability, the finding of hiatal hernia is still at low level in China. How to increase the finding or diagnosis of this disease and improve the life quality of patients, is an important task of radiologists and hernial surgeons. Surgery has been integrated into the therapy of hiatal hernia for a long time, but most surgeons still need to improve their recognition about its essence and the anti-reflux mechanism of lower esophagus. The purpose of surgery of hiatal hernia is not only to repair the defect, but to recover the anatomic structure and function of lower esophagus, as well as to rebuild anti-reflux barrier in stomach at the mean time. The key principle of surgery is to recover structure of GEJ, location of LES and the length of lower esophagus through fundoplication and firm fixation, which prevent it from dislocating to thoracic cavity. By adhering to the principle of this, we can combine the anatomy and function in repair of hiatal hernia, and recover and keep the anti-reflux function of LES utmost. MDT, specialized precision program and standardization will play more and more important roles in hiatal hernia therapy in the future. In this article, we made a review about the diagnosis and therapy history of hiatal hernia, as well as prospected the progress in the near future.
China ; Esophagus ; physiopathology ; Fundoplication ; Gastroesophageal Reflux ; Hernia, Hiatal ; diagnosis ; surgery ; Humans

OBJECTIVETo explore the risk factors and clinical characteristics of non-erosive reflux disease (NERD) based on a prospective single disease database of functional gastrointestinal disease.

METHODSUsing a customized case report form, we collected the personal and clinical data of all study participants in an online database for further analysis. High-resolution manometry and multichannel intraluminal impedance-pH monitoring were performed in some cases.

RESULTSA total of 504 NERD cases and 152 control cases were included in our database. The NERD patients consisted of 266 (52.8%) female patients and 238 (47.2%) male patients; 32.7% of the patients were from rural areas and 67.3% from urban areas; 23.1% of the patients worked in the line of business, 19.6% were civil servants, 19.2% were unemployed, and 17.1% were workers; the mean disease duration of the patients was 27.88∓16.33 month. Our analysis showed that adverse events in life (P=0.045, OR=1.954), frequent drinking (P=0.040, OR=3.957), snoring (P=0.002, OR=2.334), late meals (P=0.002, OR=2.752), and anxiety or depression (P=0.003, OR=2.723) were all independent risk factors for NERD. Of these patients, 60.81% had varying degrees of ineffective contraction of the esophageal body. The total liquid reflux events differed significantly between NERD patients with hiatal hernia and those without (P<0.05).

CONCLUSIONUnhealthy eating habits and lifestyle, history of adverse events, anxiety and depression, snoring, poor esophageal motor function and hiatal hernia are significant factors contributing to NERD, which is related with occupation and living areas and occurs most commonly at 30-50 years of age.

Databases, Factual ; Female ; Gastroesophageal Reflux ; diagnosis ; physiopathology ; Humans ; Male ; Manometry ; Prospective Studies ; Risk Factors

Achalasia is an esophageal motility disorder that is commonly misdiagnosed initially as gastroesophageal reflux disease. Patients with achalasia often complain of dysphagia with solids and liquids but may focus on regurgitation as the primary symptom, leading to initial misdiagnosis. Diagnostic tests for achalasia include esophageal motility testing, esophagogastroduodenoscopy and barium swallow. These tests play a complimentary role in establishing the diagnosis of suspected achalasia. High-resolution manometry has now identified three subtypes of achalasia, with therapeutic implications. Pneumatic dilation and surgical myotomy are the only definitive treatment options for patients with achalasia who can undergo surgery. Botulinum toxin injection into the lower esophageal sphincter should be reserved for those who cannot undergo definitive therapy. Close follow-up is paramount because many patients will have a recurrence of symptoms and require repeat treatment.
Botulinum Toxins/administration & dosage ; Deglutition Disorders/etiology ; Diagnostic Errors ; Endoscopy, Digestive System ; Esophageal Achalasia/*diagnosis/etiology/physiopathology/therapy ; Esophageal Sphincter, Lower ; Esophagus/physiopathology/surgery ; Gastroesophageal Reflux/diagnosis ; Humans ; Injections, Subcutaneous ; Manometry ; Neurotransmitter Agents/administration & dosage ; Recurrence

OBJECTIVE: To discuss the pressure changing characteristics of upper esophageal sphincter (UES), lower esophageal sphincter (LES) and the esophagus kinetic characteristics of pharyngeal paraesthesia patients. METHOD: To take high resolution manometry in 44 cases of pharyngeal paraesthesia patients and 23 normal subjects separately. According to the RSI score,the 44 patients were divided into group A (the group without reflux, RSI < 13, n = 25) and group B (the group with reflux, RSI ≥ 13, n = 19). RESULT: The UES average resting pressure and average residual pressure of patients group were higher than the control group (P < 0.05); The UES average resting pressure and average residual pressure of group B were higher than group A (P < 0.05); The LES average resting pressure and average residual pressure of group B were lower than group A and the control group (P < 0.05); The comparison of LES average resting pressure and average residual pressure between group A and the control group was not statistically significant (P > 0.05). The esophagus DCI of group B was lower than that of group A and control group (P < 0.05). The esophagus DCI comparison between group A and control group was not statistically significant (P > 0.05). CONCLUSION The pharyngeal paresthesia symptoms of'patients was associated with the increasing of UES pressure. The pharyngeal paresthesia symptoms of group with reflux was related to low pressure of LES and high pressure of UES. The last part of esophagus of group with reflux had obstacles in powers, which weaken the peristalsis and declined the ability to clear the bolus and gastric reflux material.
Case-Control Studies ; Esophageal Sphincter, Lower ; physiopathology ; Esophageal Sphincter, Upper ; physiopathology ; Gastroesophageal Reflux ; physiopathology ; Humans ; Manometry ; Paresthesia ; diagnosis ; pathology ; Peristalsis ; Pharynx ; physiopathology ; Pressure

OBJECTIVETo evaluate the clinical application of 24-hour esophageal multichannel intraluminal impedance-pH monitoring technique in preterm infants.

METHODThis study enrolled 28 preterm (male 20, female 8) infants with symptoms suggestive of gastroesophageal reflux (GER) (frequent regurgitations, apnea, or transcutaneous oxygen saturation decreased). They had postmenstrual age from 26 to 32 weeks, median (28.9 ± 1.9)weeks, had birth weight from 850 to 1 700 g, median (1 250.4 ± 272.8)g, range 850-1700 g, and were studied at corrected gestational age from 28 to 40 weeks, median (34.5 ± 2.3)weeks. Combined measurement of esophageal pH and impedance was performed. The 24-hour pH-impedance recording was uploaded onto a portable storage card and for computer-assisted manual analysis, using a specialized software program. When values were distributed normally, they were presented as mean and standard deviation, compared using t test. When values were not distributed normally, they were presented as median, minimum and maximum. Median values were compared using the Mann-Whitney U non-parametric test. SPSS 17.0 software was used.

RESULTIn 28 preterm infants, 71.4% (20/28) had pathological acid refluxes with pH monitor, while 100% with combined measurement of esophageal pH and impedance. Gestational age, birth weight, corrected gestational age had no association with acid GER. Frequent regurgitations, apnea, or transcutaneous oxygen saturation decreased but there was no statistically significant difference between acid GER group and non-acid GER group. Eight cases had no pathological acid refluxes, but showed an increase of weakly acid refluxes than pathological acid refluxes group (P < 0.01) . The median number of reflux events in 24 hours for 28 cases was 64.5 (0-377) , 23.4% were acidic, while 76.4% were weakly acidic; 59.1% were liquid bolus refluxes, while 40.9% were mixed bolus refluxes. The positive ratio of symptoms related index and symptoms association probability were significantly increased combined measurement of esophageal pH and impedance versus pH monitor were used.

CONCLUSIONThe 24-hour esophageal impedance-pH monitoring technique was safe and had good tolerance. We confirmed that it detected more weakly acidic refluxes, liquid bolus refluxes, and mixed bolus refluxes. And it provided more evidence for explaining the relationship between GER and clinical manifestation.

Electric Impedance ; Esophageal pH Monitoring ; Esophagus ; physiopathology ; Female ; Gastric Acidity Determination ; Gastroesophageal Reflux ; diagnosis ; physiopathology ; Humans ; Infant, Newborn ; Infant, Premature ; Infant, Premature, Diseases ; diagnosis ; physiopathology ; Male ; Monitoring, Physiologic ; methods ; Sensitivity and Specificity

Child ; Chronic Disease ; Cough ; etiology ; therapy ; Diagnosis, Differential ; Esophageal pH Monitoring ; Esophagus ; pathology ; physiopathology ; Gastroesophageal Reflux ; complications ; diagnosis ; therapy ; Humans ; Infant ; Monitoring, Physiologic ; Respiratory Hypersensitivity ; etiology ; therapy ; Stomach ; pathology ; physiopathology

The response rules of pressing pain on the back section in the Governor Vessel in patients with gastro-esophageal reflux disease (GERD) were studied to provide references for the diagnosis and treatment of GERD. Seventy-six cases of GERD were included into an observation group while 30 healthy volunteers were recruited into a control group. A mechanical measurement device of pressing pain that could measure the pain threshold was adapted to observe the pressing pain on the back section in the Governor Vessel in GERD patients and healthy volunteers. The test area is from spinous process of the 1st thoracic vertebra to that of the 12th thoracic vertebra (T1 -T12), including acupoints and non-acupoints on the Governor Vessel. As a result, in the observation group the pain threshold of T5-T7 spinous process clearance, which was the location of Shendao (GV 11), Lingtai (GV 10) and Zhiyang (GV 9), was lower than that in the control group (all P < 0.05). This result indicated that there was significant pressing pain in T5-T7 spinous process clearance in patients with GERD, which could be taken as an important auxiliary diagnosis and a new thinking method in the treatment of GERD with acupuncture.
Adolescent ; Adult ; Aged ; Diagnosis, Differential ; Female ; Gastroesophageal Reflux ; diagnosis ; physiopathology ; Humans ; Male ; Meridians ; Middle Aged ; Pressure ; Sensation ; Thoracic Vertebrae ; physiopathology ; Young Adult

BACKGROUNDSymptoms, endoscopy, and pH monitoring form the basis of diagnosis of gastroesophageal reflux disease (GERD). Their relationship was meaningful for primary care physicians, but still unclear. Our research aimed to compare questionnaire, endoscopy, and pH monitoring and to analyze their correlations.

METHODSThree hundred patients who underwent the Reflux Disease Questionnaire (RDQ), endoscopy, and esophageal 24-hour pH monitoring from March 2007 to December 2010 in Peking University People's Hospital were enrolled. We analyzed the characteristics of different investigations and their relationships.

RESULTSMale (OR for mild reflux esophagitis (RE) = 2.433, severe RE = 8.386), body mass index (BMI) (OR for mild RE = 1.222, severe RE = 1.297), and hernia (OR for mild RE = 6.059, severe RE = 17.547), were found to be the risk factors for RE; age (OR = 1.074) was correlated with severe RE. The consistency of questionnaire, endoscopy, and pH monitoring was poor: RDQ did not agree well with pH monitoring (κ = 0.061), nor with endoscopy (κ = 0.044); pH monitoring did not agree well with endoscopy (κ = 0.316). However, the severity of mucosa injury in RE was associated with pathological acid exposure (PAE): reflux episodes of >5 minutes (P = 0.035), the percentage time pH <4 (P = 0.017), and the DeMeester score (P = 0.016) increased significantly in patients with severe RE. Chest pain had poor relationship with RE or PAE.

CONCLUSIONSMale, age, BMI, and hernia were probably risk factors for esophagitis. RDQ, endoscopy, and pH monitoring have their own focus and reinforce each other in diagnosis. Of the GERD symptoms, chest pain had negative correlation with RE or PAE.

Adult ; Aged ; Body Mass Index ; Esophageal pH Monitoring ; Esophagitis ; etiology ; pathology ; physiopathology ; Female ; Gastroesophageal Reflux ; complications ; pathology ; physiopathology ; Hernia ; complications ; pathology ; physiopathology ; Humans ; Male ; Middle Aged ; Risk Factors

Transient lower esophageal sphincter (LES) relaxation (TLESR) is defined as LES relaxation without a swallow. TLESRs are observed in both of the normal individuals and the patients with gastroesophageal reflux disorder (GERD). However, TLESR is widely considered as the major mechanism of the GERD. The new equipments such as high resolution manometry and impedance pH study is helped to understand of TLESR and the related esophageal motor activities. The strong longitudinal muscle contraction was observed during development of TLESR. Most of TLESRs are terminated by TLESR related motor events such as primary peristalsis and secondary contractions. The majority of TLESRs are associated with gastroesophageal reflux. Upper esophageal sphincter (UES) contraction is mainly associated with liquid reflux during recumbent position and UES relaxation predominantly related with air reflux during upright position. The frequency of TLESR in GERD patients seems to be not different compared to normal individuals, but the refluxate of GERD patients tend to be more acidic during TLESR.
Esophageal Sphincter, Lower/*physiology ; Esophagogastric Junction/physiology ; Esophagus/*physiology ; Gastroesophageal Reflux/*physiopathology ; Humans ; Muscle Relaxation/physiology

Gastroesophageal reflux disease (GERD) is the most common gastrointestinal diagnosis recorded during visits to outpatient clinics in west countries. The prevalence of symptom-defined GERD in China is as high as 3% to 5%. Asa dysfunction, GERD is characterized by reflux and heartburn. The pathophysiologic process of GERD is very complicated and subtle. The spectrum of injury from long-term reflux of acid or bile includes damage mucosa, Barrett's esophagus, dysplasia, and esophageal cancer. Therefore, the therapies of GERD should focus on controlling symptom,treating complications, and surveillance the possibility of oncologic transform. As with therapy with proton-pump inhibitors (PPI), modifying lifestyle is another most important modality for most GERD. The window of surgical treatment for GERD is narrow. Surgical therapy is alternative management approach to the patients with PPI failure, complications, or huge hernia. The laparoscopic minimally invasive procedure improves the acceptance of patients to surgical therapy, but the long-term complication and drawbacks of anti-reflux surgery cannot be ignored, and which is even more common than open procedures. The limitations of current therapy for GERD have encouraged a search for more effective treatment.The Linx sphincter augmentation device has been developed to address this gap with improvement of the barrier function of LES and reversible design if necessary.
Gastroesophageal Reflux ; diagnosis ; physiopathology ; surgery ; therapy ; Humans