Gryglewski Andrzej, Pasternak Artur, Piech Krzysztof, Gąsior Grzegorz, Głowacki Roman, Bereza Krzysztof, Walocha Ewa
Department of Anatomy, Jagiellonian University Medical College, Kopernika 12, Kraków, Poland.
Folia Med Cracov. 2016;56(4):5-12.
There are still many doubts in the literature regarding gastroesophageal mucosal prolapse (GEMP) and its clinical course. We still do not know what determines mucosal wedging in esophagogastric junction, and what is the role of the anatomy of that site. To investigate that problem we performed 120 upper digestive tract endoscopies in which a hiatal hernia was diagnosed. Patients referred to our unit with different complaints most frequently of typical or atypical gastroesophageal (GE) reflux symptoms. The aim of that study was to assess hernia dimensions in patients with and without GEMP diagnosed during endoscopy. Additionally we analyzed the type and prevalence of gastrointestinal symptoms reported by patients to confirm the observation that GEMP symptoms differ from gastroesophageal reflux disease (GERD) symptoms.
One-hundred and twenty patients were included in this study. All of the patients were diagnosed with a hiatal hernia during routine gastroscopy. Using standardized methodology the region of the hiatal hernia was photographed, and hernia longitudinal and transverse dimensions were measured.
The study group comprised 57 females (52.5%) and 63 males - mean age (SD) 58.5 ± 18.4. Most of the patients had standard GERD symptoms (n = 96; 80%). The average length of hiatus, in patients with GEMP (n = 24; 20%) was 3.56 ± 0.59 cm, and the average width was 2.32 ± 0.62 cm (n = 96; 80%) vs. 4.64 ± 0.74 cm and 2.98 ± 0.68 cm respectively in patients without GEMP (p <0.001).
GEMP occurs in smaller sized hiatal hernias. We confirmed that disease symptoms of the majority of patients with GEMP differ from patient with GERD but without GEMP. However this difference was not significant enough to allow to differentiate between diagnoses based solely on the symptoms.
关于胃食管黏膜脱垂（GEMP）及其临床病程，文献中仍存在许多疑问。我们仍不清楚是什么决定了食管胃交界处的黏膜楔入，以及该部位的解剖结构有何作用。为了研究这个问题，我们对120例诊断为食管裂孔疝的患者进行了上消化道内镜检查。转诊至我们科室的患者有不同的主诉，最常见的是典型或非典型胃食管（GE）反流症状。该研究的目的是评估在内镜检查中诊断出有或无GEMP的患者的疝大小。此外，我们分析了患者报告的胃肠道症状的类型和患病率，以证实GEMP症状与胃食管反流病（GERD）症状不同的观察结果。
本研究纳入120例患者。所有患者在常规胃镜检查中均被诊断为食管裂孔疝。采用标准化方法拍摄食管裂孔疝区域，并测量疝的纵向和横向尺寸。
研究组包括57名女性（52.5%）和63名男性，平均年龄（标准差）为58.5±18.4岁。大多数患者有标准的GERD症状（n = 96；80%）。GEMP患者（n = 24；20%）的平均裂孔长度为3.56±0.59 cm，平均宽度为2.32±0.62 cm（n = 96；80%），而无GEMP患者的平均长度和宽度分别为4.64±0.74 cm和2.98±0.68 cm（p <0.001）。
GEMP发生于较小尺寸的食管裂孔疝。我们证实，大多数GEMP患者的疾病症状与无GEMP的GERD患者不同。然而，这种差异不足以仅根据症状来区分诊断。
