Abrahão Luiz João, Lemme Eponina Maria de Oliveira, Carvalho Beatriz Biccas, Alvariz Angela, Aguero Gustavo Carlos Calcena, Schechter Rosana Bihari
Serviço de Gastroenterologia, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ.
Arq Gastroenterol. 2006 Jan-Mar;43(1):37-40. doi: 10.1590/s0004-28032006000100010. Epub 2006 May 8.
In the last few years studies have demonstrated that hiatal hernias have an important role in the pathogenesis of reflux disease, promoting reflux by many different mechanisms, emphasizing that the larger the hiatal hernia, the higher the reflux intensity and erosive esophagitis prevalence.
To correlate the size of hiatal hernias (small or large) with reflux intensity (measured by pH monitoring parameters) in patients with non-erosive and erosive reflux disease.
We reviewed pH monitoring from patients with typical reflux symptoms (heartburn) previously submitted to upper endoscopy. Reflux intensity was measured by the % of total time of pH < 4 (%TT) and by % of time of pH < 4 in upright (%UT) and supine (%ST) positions. Patients were classified as non-erosive reflux disease if no erosive esophagitis was found in endoscopy and pH monitoring was abnormal and as erosive reflux disease if they had erosive esophagitis. Hiatal hernias were classified as small if their size ranged from 2 to 4 cm and large if > or = 5 cm.
A total of 192 patients were included, being 115 in erosive reflux disease group and 77 in non-erosive reflux disease group. In erosive reflux disease patients, there were 94 (81%) with small hiatal hernias and 21 (19%) with large ones and in non-erosive reflux disease patients there were 66 (85%) with small and 11(15%) with large hiatal hernias. In erosive reflux disease group, the %TT, %UT and %ST were of 13.1 +/- 7.1; 13.4 +/- 7.4 and 12.3 +/- 11.5 in small hiatal hernias and 20.2 +/- 12.3; 17.8 +/- 14.1 and 20.7 +/- 14.1 in large hiatal hernias, respectively (P < 0.05 for %TT and %TS). In non-erosive reflux disease patients, %TT, %UT and %ST were 9.6 +/- 4.8; 10.8 +/- 6.8 and 8.6 +/- 7.3 in small hiatal hernias and of 14.6 +/- 13.3; 11.2 +/- 7.5 and 18.1 +/- 21.0 in large hiatal hernias respectively (P < 0.05 for %TT and %TS).
Large hiatal hernias increase acid exposure time only in supine position in erosive esophagitis patients and in non-erosive patients.
在过去几年中，研究表明食管裂孔疝在反流性疾病的发病机制中起重要作用，通过多种不同机制促进反流，强调食管裂孔疝越大，反流强度和糜烂性食管炎患病率越高。
在非糜烂性和糜烂性反流性疾病患者中，将食管裂孔疝的大小（小或大）与反流强度（通过pH监测参数测量）相关联。
我们回顾了先前接受上消化道内镜检查且有典型反流症状（烧心）患者的pH监测情况。反流强度通过pH < 4的总时间百分比（%TT）以及直立位（%UT）和仰卧位（%ST）时pH < 4的时间百分比来测量。如果内镜检查未发现糜烂性食管炎且pH监测异常，则将患者分类为非糜烂性反流性疾病；如果有糜烂性食管炎，则分类为糜烂性反流性疾病。食管裂孔疝大小在2至4 cm之间为小，≥5 cm为大。
共纳入192例患者，其中糜烂性反流性疾病组115例，非糜烂性反流性疾病组77例。在糜烂性反流性疾病患者中，小食管裂孔疝患者94例（81%），大食管裂孔疝患者21例（19%）；在非糜烂性反流性疾病患者中，小食管裂孔疝患者66例（85%），大食管裂孔疝患者11例（15%）。在糜烂性反流性疾病组中，小食管裂孔疝的%TT、%UT和%ST分别为13.1±7.1、13.4±7.4和12.3±11.5，大食管裂孔疝分别为20.2±12.3、17.8±14.1和20.7±14.1（%TT和%TS，P < 0.05）。在非糜烂性反流性疾病患者中，小食管裂孔疝的%TT、%UT和%ST分别为9.6±4.8、10.8±6.8和8.6±7.3，大食管裂孔疝分别为14.6±13.3、11.2±7.5和18.1±21.0（%TT和%TS，P < 0.05）。
大食管裂孔疝仅在糜烂性食管炎患者和非糜烂性患者的仰卧位增加酸暴露时间。
