Division of Gastroenterology, Washington University in St Louis, St Louis, MO, USA.
Barts and the London School of Medicine and Dentistry, Queen Mary Institute of London, London, UK.
Neurogastroenterol Motil. 2020 Dec;32(12):e13947. doi: 10.1111/nmo.13947. Epub 2020 Jul 20.
Paraesophageal hernias (PEH) can be associated with obstructive symptoms, but high-resolution manometry (HRM) characteristics have not been described in detail.
HRM studies of confirmed PEH patients (n = 60, 66.3 ± 1.5 years, 76.7% F), axial hernias (n = 125, 56.1 ± 1.1 years, 58.4% F), and healthy controls (n = 20, 27.9 ± 0.7 years, 45% F) were analyzed. Axial hernias (type 1) were compared to PEH subtyped as isolated PEH (type 2), PEH with axial hernia (type 3), PEH with herniated abdominal organs (type 4), and unknown. Distal contractile integral (DCI), esophageal length, lower esophageal sphincter pressures (LESP), EGJ contractile integral (EGJ-CI), and integrated relaxation pressure (IRP) were extracted. Intra-luminal pressures were measured proximal (intrabolus pressure, IBP) and distal (intragastric pressure, IGP) to EGJ. Univariate and multivariate analyses were performed to characterize esophageal and EGJ motor physiology in PEH.
PEH patients had LESP and EGJ-CI similar to controls; axial hernia patients had lower LESP. While IRP was within normal limits, PEH had elevated IBP and IGP, and shorter esophageal length compared to axial hernia and normal controls (P ≤ .0001 across groups). Short esophageal length was consistent across PEH subtypes (P = .06). On multivariate regression analysis, IBP remained an independent predictor of PEH (P < .0001). Within PEH subtypes, gastric pressure was higher when axial HH was also present, in contrast to isolated PEH (P = .03); other metrics did not differ.
CONCLUSIONS & INFERENCES: Luminal pressure increase both upstream and downstream of the EGJ on HRM likely represents obstructive phenomena in PEH, identification of which may support suspicion of PEH.
食管旁疝 (PEH) 可与阻塞症状相关，但高分辨率测压 (HRM) 的特征尚未详细描述。
对确诊的 PEH 患者（n=60，66.3±1.5 岁，76.7%女性）、轴向疝（n=125，56.1±1.1 岁，58.4%女性）和健康对照者（n=20，27.9±0.7 岁，45%女性）的 HRM 研究进行了分析。将轴向疝（类型 1）与以下类型的 PEH 进行比较：单纯性 PEH（类型 2）、伴轴向疝的 PEH（类型 3）、伴疝入腹部器官的 PEH（类型 4）和不明原因的 PEH。提取远端收缩积分 (DCI)、食管长度、食管下括约肌压力 (LESP)、食管胃结合部收缩积分 (EGJ-CI) 和整合松弛压 (IRP)。在食管胃结合部近端 (腔内压力，IBP) 和远端 (胃内压，IGP) 测量腔内压力。采用单变量和多变量分析来描述 PEH 患者的食管和食管胃结合部运动生理学。
PEH 患者的 LESP 和 EGJ-CI 与对照组相似；轴向疝患者的 LESP 较低。尽管 IRP 处于正常范围内，但与轴向疝和正常对照组相比，PEH 的 IBP 和 IGP 较高，食管长度较短（各组 P≤.0001）。PEH 各亚型的食管长度较短（P=0.06）。多变量回归分析显示，IBP 仍然是 PEH 的独立预测因素（P<0.0001）。在 PEH 各亚型中，当轴向 HH 也存在时，胃内压较高，与单纯性 PEH 不同（P=0.03）；其他指标没有差异。
HRM 上食管胃结合部上下游的腔内压力升高可能代表 PEH 的阻塞现象，对其的识别可能有助于怀疑 PEH。
