Ott D J, Glauser S J, Ledbetter M S, Chen M Y, Koufman J A, Gelfand D W
Department of Radiology, Bowman Gray School of Medicine, Wake Forest University, Winston-Salem, NC 27157-1088, USA.
AJR Am J Roentgenol. 1995 Sep;165(3):557-9. doi: 10.2214/ajr.165.3.7645469.
The relationship of hiatal hernia to gastroesophageal reflux disease remains controversial. Previous endoscopic and radiologic studies of hiatal hernia and reflux esophagitis have shown that hiatal hernia is a poor predictor of the presence of endoscopic esophagitis, especially for smaller hernias. Similar correlations with 24-hr pH monitoring have not been done. The purpose of this study was to determine if there is a correlation between the presence and size of hiatal hernias and gastroesophageal reflux using 24-hr pH monitoring as a measure of the degree of reflux.
We reviewed the barium esophagograms and the results of pH monitoring of the esophagus in 319 patients (161 women and 158 men; mean age, 51 years). The presence and size of hiatal hernia were determined from the radiographic examination; size was categorized as "minimal" or "larger" (> or = 2 cm axial length). An abnormal result of pH monitoring was defined as a pH less than 4 for 6% or more of the 24-hr observation time.
Abnormal results of pH monitoring were found in 61 (31%) of 199 patients with hiatal hernia compared with 21 (18%) of 120 patients without hiatal hernia (p < .05). Abnormal findings of pH monitoring were present in 33 (35%) of 95 patients with a larger hiatal hernia versus 28 (27%) of 104 patients with a minimal hiatal hernia (p > .05); a significant difference (p < .05) was observed when patients without hiatal hernia were compared with those with a larger hiatal hernia.
Most patients in this study had normal results of pH monitoring of the esophagus regardless of the presence or absence of hiatal hernia. However, patients with larger hiatal hernias were more likely to have abnormal findings on pH monitoring; hiatal hernias of minimal size were a poorer predictor of the presence of abnormal gastroesophageal reflux.
食管裂孔疝与胃食管反流病之间的关系仍存在争议。以往关于食管裂孔疝和反流性食管炎的内镜及放射学研究表明，食管裂孔疝对内镜下食管炎的存在情况预测性较差，尤其是对于较小的疝。尚未进行过与24小时pH监测的类似相关性研究。本研究的目的是使用24小时pH监测作为反流程度的指标，确定食管裂孔疝的存在及大小与胃食管反流之间是否存在相关性。
我们回顾了319例患者（161例女性和158例男性；平均年龄51岁）的食管钡餐造影和食管pH监测结果。通过放射学检查确定食管裂孔疝的存在及大小；大小分为“最小”或“较大”（轴向长度≥2 cm）。pH监测结果异常定义为在24小时观察时间内pH值小于4的时间占6%或更多。
199例有食管裂孔疝的患者中，61例（31%）pH监测结果异常，而120例无食管裂孔疝的患者中，21例（18%）pH监测结果异常（p<0.05）。95例较大食管裂孔疝患者中，33例（35%）pH监测有异常发现，而104例最小食管裂孔疝患者中，28例（27%）pH监测有异常发现（p>0.05）；将无食管裂孔疝的患者与较大食管裂孔疝的患者进行比较时，观察到显著差异（p<0.05）。
本研究中的大多数患者，无论有无食管裂孔疝，食管pH监测结果均正常。然而，较大食管裂孔疝的患者pH监测更可能有异常发现；最小尺寸的食管裂孔疝对异常胃食管反流存在情况的预测性较差。
