Objective Assessment of Gastroesophageal Reflux Secondary to Hiatal Hernia

Abstract

In our experience, direct measurement of intraluminal pressure and pH about the gastroesophageal junction has been a distict aid in the diagnosis and management of patients with hiatal hernias. The studies are done as follows: a pH electrode to which has been attached an open-ended, water-filled polyethylene tube is passed transnasally into the stomach. Withdrawal of this device allows for continuous measurement of pressure and pH in the stomach, at the gastroesophageal junction, and in the esophagus. By such measurements, detection of reflux of acid gastric juice into the distal esophagus can be assessed objectively. By comparison with x-ray study, direct measurement of pH and pressure is highly sensitive in the detection of gastroesophageal reflux. Among 115 patients with symptomatic sliding hiatal hernias, reflux was demonstrated by fluoroscopic examination in 26. By the technique described above, reflux was discovered in 94. Twenty-five patients with sliding hiatal hernias were subjected to both preoperative and postoperative measurements of intraluminal pH and pressure. There were two verified recurrences of hernia. Of the remainder, there were 22 with demonstrated reflux preoperatively. In 18 of these, the reflux was either completely corrected or improved postoperatively. Generally, freedom from symptoms accompanied correction of reflux. Because of failure to improve reflux in four patients and follow-up not exceeding 21 months, we are not able, as yet, to offer truly firm convictions concerning the most efficacious methods of surgical repair.