Impact of hiatal hernia on histological pattern of non-erosive reflux disease

Vassilios Papadopoulos,Efthimios Sivridis,Konstantinos Mimidis,Alexandros Polychronidis,Nikolaos Lyratzopoulos,Georgios Minopoulos,Alexandra Giatromanolaki,Anthie Gatopoulou

doi:10.1186/1471-230x-5-2

Vassilios Papadopoulos, Efthimios Sivridis + Show 6 more

Open Access

https://doi.org/10.1186/1471-230x-5-2

Copy DOI

Journal: BMC Gastroenterology	Publication Date: Jan 9, 2005
Citations: 37	License type: cc-by

Affiliation: Democritus University of Thrace

Abstract

BackgroundHiatus hernia (HH) has major pathophysiological effects favoring gastroesophageal reflux and hence contributing to esophageal mucosa injury, especially in patients with severe gastroesophageal disease. However, prospective studies investigating the impact of HH on the esophageal mucosa in non-erosive reflux disease (NERD) are lacking. This study evaluated the association between the presence of (HH) and the histological findings in symptomatic patients with NERD.MethodsFifty consecutive patients with gastroesophageal reflux disease (GERD) were enrolled. After conventional endoscopy, Lugol solution was applied and biopsy specimens were obtained. Histological parameters including basal zone hyperplasia, papillary length and cellular infiltration were evaluated. The chi-square test with Yates' correlation was used for comparing discrete parameters between groups. However, Fisher's exact probability test was used where the expected frequencies were lower than 5. Wilcoxon's test for unpaired samples was preferred in cases of semi-quantitative parameters.ResultsThe presence of HH along with more severe findings (0.01 <P < 0.05) was confirmed in 18 patients. NERD was observed in 29 (58%) patients. Basal zone hyperplasia and loss of glycogen accompanied HH in all cases, and the correlation was significant in NERD (P < 0.001). The remaining histological patterns were similar between erosive reflux disease and NERD in the presence of HH.ConclusionThe presence of HH is correlated with more severe endoscopy findings, and predisposes for severe histological abnormality in cases of NERD.

Highlights

Hiatus hernia (HH) has major pathophysiological effects favoring gastroesophageal reflux and contributing to esophageal mucosa injury, especially in patients with severe gastroesophageal disease
HH+ appears to be a risk factor for non-erosive reflux disease (NERD), but is suggestive of the histological presence of microscopic Gastroesophageal reflux disease (GERD) in symptomatic NERD patients. This finding could play an important role in the therapeutic management of NERD patients with pump inhibitors (PPIs) in the future, since ERD patients respond better than NERD patients to antireflux therapy
Our prospective study suggests that HH+, even in patients with an esophageal mucosa that appears normal endoscopically (NERD), indicates the existence of histological effects

Summary

Introduction

Hiatus hernia (HH) has major pathophysiological effects favoring gastroesophageal reflux and contributing to esophageal mucosa injury, especially in patients with severe gastroesophageal disease. Gastroesophageal reflux disease (GERD) is a common condition that affects 25–30% of the population [1]. It clearly involves multifactorial pathophysiology, yet the factors underlying why only some patients develop reflux esophagitis are unclear [2]. More than twothirds of all patients with reflux symptoms never develop esophageal erosions, ulcers or strictures [3]. This group of NERD patients constitutes a significant clinical problem since they appear to be relatively resistant to proton-pump inhibitors (PPIs) [4,5]

Objectives

Methods

Results

Discussion

Conclusion