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Bolus retention in hiatal hernia identified by high‐resolution esophageal manometry with impedance
Author(s) -
Shin G. H.,
Sankineni A.,
Parkman H. P.
Publication year - 2014
Publication title -
neurogastroenterology and motility
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.489
H-Index - 105
eISSN - 1365-2982
pISSN - 1350-1925
DOI - 10.1111/nmo.12312
Subject(s) - hiatal hernia , bolus (digestion) , medicine , high resolution manometry , esophageal sphincter , reflux , gastroenterology , hernia , cardiology , surgery , disease
Background Esophageal acid retention in a hiatal hernia ( HH ) may play a role in gastro‐esophageal reflux. The aims of this study were to determine the prevalence of bolus retention ( BR ) in HH and to compare pressure profiles in patients with HH with BR in the hernia to those with bolus clearance ( BC ) through the hernia using high‐resolution esophageal manometry with impedance ( HREMI ). Methods Clinical HREMI studies with HH ≥1.5 cm were analyzed for lower esophageal sphincter ( LES ) and crural diaphragm ( CD ) pressures and pressure profiles during 12 saline swallows. Impedance was analyzed for swallow retention in the HH . Key Results Bolus retention in a HH was present in 35 of 53 (66%) patients with a HH . Patients with BR had overall lower pressure profiles including a lower basal LES pressure (14.8 ± 10.6 vs 28.9 ± 16.8 mmHg; p = 0.0001), LES ‐ CD gradient (6.8 ± 17.9 vs 20.6 ± 12.2 mmHg; p = 0.002), residual LES pressure (2.5 ± 4.6 vs 6.1 ± 12.2 mmHg; p = 0.017), amplitude of distal esophageal contractions (83.2 ± 38.8 vs 111.2 ± 42.8 mmHg; p = 0.020), and distal contractile integral (1487 ± 1016 vs 2608 ± 1221 mmHg‐cm‐sec; p = 0.001) compared to the BC group. Patients with BR were more likely to have a larger sized HH compared to the BC group (3.1 ± 1.6 vs 2.1 ± 0.6 cm; p = 0.016); similar pressure changes were found when the groups were divided up by HH sizes. Conclusions & Inferences Bolus retention was seen in 66% of patients with HH . Bolus retention in the HH was associated with larger HH size, lower LES pressure, and lower esophageal contractile pressures compared to those with BC .