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. 1993 May;68(5):662–664. doi: 10.1136/adc.68.5.662

Role of hiatal hernia in delaying acid clearance.

R J Stewart 1, B T Johnston 1, V E Boston 1, J Dodge 1
PMCID: PMC1029337  PMID: 8323336

Abstract

The aim of this study was to assess prospectively the relationship of a hiatal hernia to gastro-oesophageal reflux. Ninety five children with symptoms of gastro-oesophageal reflux in whom reflux was demonstrated radiologically were investigated. Oesophageal pH monitoring for 18 hours and endoscopy were performed in all patients. On the basis of radiology, patients were divided into those with hiatal hernia (n = 37) and those without (n = 58). Both groups had the same number of reflux episodes on pH monitoring. However, the median duration of the longest episode was significantly greater in the hiatal hernia group (30 min v 19 min), as was the number of reflux episodes longer than five minutes (5 v 4). The percentage with a pH < 4 just failed to be significantly different (13% v 8%). Hiatal hernia was also found to correlate with the presence of oesophagitis. The presence of a hiatal hernia delays the clearance of acid from the oesophagus and is associated with an increased incidence of oesophagitis.

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Selected References

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  1. Agunod M., Yamaguchi N., Lopez R., Luhby A. L., Glass G. B. Correlative study of hydrochloric acid, pepsin, and intrinsic factor secretion in newborns and infants. Am J Dig Dis. 1969 Jun;14(6):400–414. doi: 10.1007/BF02239360. [DOI] [PubMed] [Google Scholar]
  2. Arana J., Tovar J. A. Motor efficiency of the refluxing esophagus in basal conditions and after acid challenge. J Pediatr Surg. 1989 Oct;24(10):1049–1054. doi: 10.1016/s0022-3468(89)80213-1. [DOI] [PubMed] [Google Scholar]
  3. Ask P., Edwall G., Johansson K. E. Accuracy and choice of procedures in 24-hour oesophageal pH monitoring with monocrystalline antimony electrodes. Med Biol Eng Comput. 1986 Nov;24(6):602–608. doi: 10.1007/BF02446263. [DOI] [PubMed] [Google Scholar]
  4. Boix-Ochoa J., Canals J. Maturation of the lower esophagus. J Pediatr Surg. 1976 Oct;11(5):749–756. doi: 10.1016/0022-3468(76)90099-3. [DOI] [PubMed] [Google Scholar]
  5. Boix-Ochoa J., Lafuenta J. M., Gil-Vernet J. M. Twenty-four hour exophageal pH monitoring in gastroesophageal reflux. J Pediatr Surg. 1980 Feb;15(1):74–78. doi: 10.1016/s0022-3468(80)80407-6. [DOI] [PubMed] [Google Scholar]
  6. CARRE I. J. The natural history of the partial thoracic stomach (hiatus hernia) in children. Arch Dis Child. 1959 Aug;34:344–353. doi: 10.1136/adc.34.176.344. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. CODE C. F., FYKE F. E., Jr, SCHLEGEL J. F. The gastroesophageal sphincter in healthy human beings. Gastroenterologia. 1956;86(3):135–150. doi: 10.1159/000200544. [DOI] [PubMed] [Google Scholar]
  8. Carré I. J. Management of gastro-oesophageal reflux. Arch Dis Child. 1985 Jan;60(1):71–75. doi: 10.1136/adc.60.1.71. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Castell D. O. The lower esophageal sphincter. Physiologic and clinical aspects. Ann Intern Med. 1975 Sep;83(3):390–401. doi: 10.7326/0003-4819-83-3-390. [DOI] [PubMed] [Google Scholar]
  10. Cohen S., Harris L. D. Does hiatus hernia affect competence of the gastroesophageal sphincter? N Engl J Med. 1971 May 13;284(19):1053–1056. doi: 10.1056/NEJM197105132841902. [DOI] [PubMed] [Google Scholar]
  11. Colson D. J., Campbell C. A., Wright V. A., Watson B. W. Predictive value of oesophageal pH variables in children with gastro-oesophageal reflux. Gut. 1990 Apr;31(4):370–373. doi: 10.1136/gut.31.4.370. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Cucchiara S., Staiano A., Gobio Casali L., Boccieri A., Paone F. M. Value of the 24 hour intraoesophageal pH monitoring in children. Gut. 1990 Feb;31(2):129–133. doi: 10.1136/gut.31.2.129. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Dent J., Dodds W. J., Hogan W. J., Toouli J. Factors that influence induction of gastroesophageal reflux in normal human subjects. Dig Dis Sci. 1988 Mar;33(3):270–275. doi: 10.1007/BF01535748. [DOI] [PubMed] [Google Scholar]
  14. Dillard D. H., Anderson H. N. A new concept of the mechanism of sphincteric failure in sliding esophageal hiatal hernia. Surg Gynecol Obstet. 1966 May;122(5):1030–1038. [PubMed] [Google Scholar]
  15. Jolley S. G., Johnson D. G., Herbst J. J., Pena A., Garnier R. An assessment of gastroesophageal reflux in children by extended pH monitoring of the distal esophagus. Surgery. 1978 Jul;84(1):16–24. [PubMed] [Google Scholar]
  16. Mahony M. J., Migliavacca M., Spitz L., Milla P. J. Motor disorders of the oesophagus in gastro-oesophageal reflux. Arch Dis Child. 1988 Nov;63(11):1333–1338. doi: 10.1136/adc.63.11.1333. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Meyers W. F., Roberts C. C., Johnson D. G., Herbst J. J. Value of tests for evaluation of gastroesophageal reflux in children. J Pediatr Surg. 1985 Oct;20(5):515–520. doi: 10.1016/s0022-3468(85)80478-4. [DOI] [PubMed] [Google Scholar]
  18. Mittal R. K., Lange R. C., McCallum R. W. Identification and mechanism of delayed esophageal acid clearance in subjects with hiatus hernia. Gastroenterology. 1987 Jan;92(1):130–135. doi: 10.1016/0016-5085(87)90849-3. [DOI] [PubMed] [Google Scholar]
  19. REX J. C., ANDERSEN H. A., BARTHOLOMEW L. G., CAIN J. C. Esophageal hiatal hernia: a 10-year study of medically treated cases. JAMA. 1961 Oct 21;178:271–274. doi: 10.1001/jama.1961.03040420011003. [DOI] [PubMed] [Google Scholar]
  20. Shub M. D., Ulshen M. H., Hargrove C. B., Siegal G. P., Groben P. A., Askin F. B. Esophagitis: a frequent consequence of gastroesophageal reflux in infancy. J Pediatr. 1985 Dec;107(6):881–884. doi: 10.1016/s0022-3476(85)80180-3. [DOI] [PubMed] [Google Scholar]
  21. Skinner D. B., Booth D. J. Assessment of distal esophageal function in patients with hiatal hernia and-or gastroesophageal reflux. Ann Surg. 1970 Oct;172(4):627–637. doi: 10.1097/00000658-197010000-00009. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Skinner D. B. Symptomatic esophageal reflux. Am J Dig Dis. 1966 Oct;11(10):771–779. doi: 10.1007/BF02233837. [DOI] [PubMed] [Google Scholar]
  23. Sloan S., Kahrilas P. J. Impairment of esophageal emptying with hiatal hernia. Gastroenterology. 1991 Mar;100(3):596–605. doi: 10.1016/0016-5085(91)80003-r. [DOI] [PubMed] [Google Scholar]
  24. Sondheimer J. M. Continuous monitoring of distal esophageal pH: a diagnostic test for gastroesophageal reflux in infants. J Pediatr. 1980 May;96(5):804–807. doi: 10.1016/s0022-3476(80)80546-4. [DOI] [PubMed] [Google Scholar]
  25. Strobel C. T., Byrne W. J., Ament M. E., Euler A. R. Correlation of esophageal lengths in children with height: application to the Tuttle test without prior esophageal manometry. J Pediatr. 1979 Jan;94(1):81–84. doi: 10.1016/s0022-3476(79)80361-3. [DOI] [PubMed] [Google Scholar]
  26. Vandenplas Y., Sacre-Smits L. Seventeen-hour continuous esophageal pH monitoring in the newborn: evaluation of the influence of position in asymptomatic and symptomatic babies. J Pediatr Gastroenterol Nutr. 1985 Jun;4(3):356–361. doi: 10.1097/00005176-198506000-00006. [DOI] [PubMed] [Google Scholar]
  27. Werlin S. L., Dodds W. J., Hogan W. J., Arndorfer R. C. Mechanisms of gastroesophageal reflux in children. J Pediatr. 1980 Aug;97(2):244–249. doi: 10.1016/s0022-3476(80)80482-3. [DOI] [PubMed] [Google Scholar]
  28. Wright R. A., Hurwitz A. L. Relationship of hiatal hernia to endoscopically proved reflux esophagitis. Dig Dis Sci. 1979 Apr;24(4):311–313. doi: 10.1007/BF01296546. [DOI] [PubMed] [Google Scholar]

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