A Higher Manometric Esophageal Length to Height Ratio in Achalasia Explains the Lower Prevalence of Hiatal Hernia.

Autor: Coss-Adame E; Department of Gastroenterology, National Institute of Medical Sciences and Nutrition Salvador Zubiran, Mexico City, Mexico., Furuzawa-Carballeda J; Department of Experimental Surgery, National Institute of Medical Sciences and Nutrition Salvador Zubiran, Mexico City, Mexico., Perez-Ortiz AC; School of Medicine, Universidad Panamericana, Mexico City, Mexico., López-Ruiz A; Department of Experimental Surgery, National Institute of Medical Sciences and Nutrition Salvador Zubiran, Mexico City, Mexico., Valdovinos MA; Department of Gastroenterology, National Institute of Medical Sciences and Nutrition Salvador Zubiran, Mexico City, Mexico., Sánchez-Gómez J; Department of Experimental Surgery, National Institute of Medical Sciences and Nutrition Salvador Zubiran, Mexico City, Mexico., Peralta-Figueroa J; Department of Experimental Surgery, National Institute of Medical Sciences and Nutrition Salvador Zubiran, Mexico City, Mexico., Olvera-Prado H; Department of Experimental Surgery, National Institute of Medical Sciences and Nutrition Salvador Zubiran, Mexico City, Mexico., López-Verdugo F; Department of Experimental Surgery, National Institute of Medical Sciences and Nutrition Salvador Zubiran, Mexico City, Mexico., Narváez-Chávez S; Department of Experimental Surgery, National Institute of Medical Sciences and Nutrition Salvador Zubiran, Mexico City, Mexico., Santés-Jasso ÓS; Department of Surgery, National Institute of Medical Sciences and Nutrition Salvador Zubiran, Mexico City, Mexico., Aguilar-León D; Department of Pathology, National Institute of Medical Sciences and Nutrition Salvador Zubiran, Mexico City, Mexico., Torres-Villalobos G; Department of Experimental Surgery, National Institute of Medical Sciences and Nutrition Salvador Zubiran, Mexico City, Mexico.; Department of Surgery, National Institute of Medical Sciences and Nutrition Salvador Zubiran, Mexico City, Mexico.
Jazyk: angličtina
Zdroj: Journal of neurogastroenterology and motility [J Neurogastroenterol Motil] 2023 Oct 30; Vol. 29 (4), pp. 501-512. Date of Electronic Publication: 2023 Aug 24.
DOI: 10.5056/jnm22139
Abstrakt: Background/aims: The evidence suggests that a shorter esophageal length (EL) in gastroesophageal reflux disease (GERD) patients is associated with the presence of hiatal hernia (HH). However, there are no reports of this association in patients with achalasia. The aim is to (1) determine the prevalence of hiatal hernia in achalasia patients, (2) compare achalasia EL with GERD patients and healthy volunteers (HV), (3) measure achalasia manometric esophageal length to height (MELH) ratio, and (4) determine if there are differences in symptoms between patients with and without hiatal hernia.
Methods: This retrospective and cross-sectional study consist of 87 pre-surgical achalasia patients, 22 GERD patients, and 30 HV. High-resolution manometry (HRM), barium swallow, and upper endoscopy were performed to diagnose HH. The EL and MELH ratio were measured by HRM. Symptoms were assessed with Eckardt, Eating Assessment Tool, and GERD-health-related quality of life questionnaires.
Results: The HH in GERD's prevalence was 73% vs 3% in achalasia patients ( P < 0.001). Achalasia patients had a longer esophagus and a higher MELH ratio than HV and GERD patients ( P < 0.001). GERD patients had a lower MELH ratio than HV ( P < 0.05). EAT-10 ( P < 0.0001) and Eckardt ( P < 0.05) scores were higher in achalasia without HH vs HH.
Conclusions: The prevalence of HH in achalasia is significantly lower than in GERD. The longer EL and the higher MELH ratio in achalasia could explain the lower prevalence of HH. Despite the low prevalence of HH in achalasia patients, the surgeon should be encouraged not to rule out HH since the risk of postoperative reflux may increase if this condition is not identified and corrected.
Databáze: MEDLINE
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