Prevalence Of Hernia Research Articles

Beyond watchful waiting: the burden of inguinal hernias in low income countries

INTRODUCTION: Inguinal hernia repair (IHR) is frequently performed during humanitarian surgical missions due to the high prevalence of hernia in low income countries (LIC). It is unclear whether the allocation of resources aimed at IHR is justified as the burden of these hernias is unknown. We hypothesized that inguinal hernias result in significant reduction in activity and productivity in LIC.

A study of pathophysiological factors associated with gastro‐esophageal reflux disease in twins discordant for gastro‐esophageal reflux symptoms

Differences in lower esophageal sphincter (LES) and peristaltic function and in transient LES relaxations (TLESR) have been described in patients with gastro-esophageal reflux disease (GERD). However, some of these differences may be the result of chronic GERD rather than being an underlying contributory factor. Twins discordant for GERD symptoms, i.e., only one twin had GERD symptoms, underwent standard LES and esophageal body manometry, and then using a sleeve sensor prolonged LES and pH monitoring, 30 min before and 60 min after a 250 mL 1200 kcal lipid meal. Eight monozygotic and 24 dizygotic female twins were studied. Although there was no difference in preprandial LES pressure (symptomatic 13.2 ± 7.1 mmHg vs asymptomatic 15.1 ± 6.2 mmHg, P = 0.4), LES pressure fell further postprandially in symptomatic twins (LES pressure area under the curve 465 ± 126 vs 331 ± 141 mmHg h, P < 0.01). 12/37 (32%) of acid reflux episodes in symptomatic twins occurred due to low LES pressure or deep inspiration/strain and 0/17 in asymptomatic twins (P = 0.01). There was no difference between symptomatic and asymptomatic twins in: peristaltic amplitude, ineffective esophageal body motility, hiatus hernia prevalence, or LES length. There was also no difference in TLESR frequency preprandially (symptomatic median 1(range 0-2) vs asymptomatic 0(0-2), P = 0.08) or postprandially (2.5(1-8) vs 3(1-6), P = 0.81). Twins with GERD symptoms had lower postprandial LES pressure and given the close genetic link between the twins, it is possible that such differences are caused by GERD. Acid reflux episodes associated with a hypotensive LES were seen in symptomatic, but not in asymptomatic twins.

Increase in gastroesophageal reflux disease symptoms and erosive esophagitis 1 year after laparoscopic sleeve gastrectomy among obese adults

Although laparoscopic sleeve gastrectomy (LSG) is an effective treatment for morbid obesity, the effects of LSG on gastroesophageal reflux disease (GERD) are controversial. This study evaluated the changes of GERD symptoms and erosive esophagitis (EE) in severely obese patients who underwent LSG.Forty-seven severely obese women and 19 severely obese men (mean age of 37.2 ± 12.7 years) who underwent LSG between August 2007 and November 2009 were enrolled. All patients completed the Reflux Disease Questionnaire and underwent esophagogastroduodenoscopy preoperatively and at least 1 year after LSG.The median follow-up period was 12 months (range, 12-21). After surgery, significant decreases were reported in mean body mass index (36.3 ± 4.1 vs. 25.8 ± 2.9 kg/m(2)), mean waist circumference (109.5 ± 12.8 vs. 85.7 ± 9.5 cm), and prevalence of metabolic syndrome (54.5 vs. 7.6 %; P < 0.001 for both). Conversely, a significant increase was observed in the prevalence of GERD symptoms (12.1 vs. 47 %) and EE (16.7 vs. 66.7 %) after LSG (P < 0.001 for both). The prevalence of hiatal hernias also increased significantly (6.1 vs. 27.3 %; P < 0.001) after LSG, and it was significantly higher in patients with than those without EE after LSG (9.1 vs. 36.4 %, respectively; P = 0.02).Although LSG can achieve significant weight loss and improvement of comorbidities in severely obese patients, the prevalence and severity of GERD symptoms and EE increase after the operation. The occurrence of EE after LSG is related to the presence of a hiatal hernia after the operation.

Prevalence of hiatal hernia in the morbidly obese

BackgroundMorbidly obese patients commonly have gastroesophageal reflux (GERD) and associated hiatal hernias. As such, some surgeons routinely perform a concomitant hiatal hernia repair during bariatric surgery. However, the intraoperative inspection for a hiatal hernia based on laparoscopic visualization can be misleading. The aim of this study was to assess the prevalence of hiatal hernias in morbidly obese patients based on preoperative upper gastrointestinal (GI) contrast study. MethodsData on 181 patients who underwent routine upper GI contrast study as part of a preoperative workup for bariatric surgery were reviewed. The upper GI studies were examined for the presence of hiatal hernias and GERD. Hiatal hernias were categorized by size as small (≤2 cm), moderate (2–5 cm), or large (>5 cm). GERD was based on radiologic evidence and categorized as mild, moderate, or severe. ResultsThe mean age of the cohort was 44 years, with a mean body mass index of 43 kg/m2. Of the 181 patients overall, based on the upper GI contrast study, the prevalence of hiatal hernia was 37.0% and of GERD was 39.8%; the prevalence of moderate or large hiatal hernia was 4.4%, and the prevalence of moderate or severe GERD was 13.3%. ConclusionsBased on upper GI contrast study, we identified the presence of a hiatal hernia in nearly 40% of morbidly obese patients. The results from this study suggest that surgeons should evaluate the morbidly obese patient for the presence of hiatal hernias and perform concomitant repair at the time of the bariatric procedure, particularly in patients undergoing gastric banding and sleeve gastrectomy, while less so in the gastric bypass patient.

Incision-related outcome after live donor nephrectomy: a single-center experience

Live donor nephrectomy is routinely performed. However, little is known regarding the incision-related outcome. The aim of the present study was to evaluate the prevalence of incisional hernias (IH) and to assess body image and cosmesis scores after donation. Questionnaires on IH, body image, and cosmesis were sent to all donors who underwent laparoscopic donor nephrectomy or mini-incision donor nephrectomy between January 2000 and December 2009. In total, 444 replies were received (75 %). Seven donors (1.5 %) had undergone a surgical correction of an IH. Surgical site infection and steroid use appeared to be independent risk factors for the development of an IH (p = 0.001 and 0.021, respectively). Body image and cosmesis scores were excellent. Elderly donors had significantly higher cosmesis scores when compared with young donors (p < 0.001). Donor age of 60 years or higher, correction of an IH, and survival of the recipient appeared to be independent factors associated with a higher score on the cosmesis scale in multivariate analysis. This is the largest study describing the prevalence of IH and cosmetic outcome after donor nephrectomy. The prevalence of IH after live donor nephrectomy is very low, and body image and cosmesis scores are excellent. Consequently, incision-related outcomes pose no barrier to live donor nephrectomy.

Comparative Effectiveness of Dynamic Abdominal Sonography for Hernia vs Computed Tomography in the Diagnosis of Incisional Hernia

Diagnosis and characterization of incisional hernia are often established by CT, which incurs radiation exposure and substantial cost in clinical practice. The purpose of this study was to determine the comparative effectiveness of surgeon-performed Dynamic Abdominal Sonography for Hernia (DASH) vs CT for incisional hernia evaluation. Patients with previous abdominal operations and recent CT imaging were enrolled prospectively; patients with stomas, fistula, or soft tissue infection were excluded. In the clinic setting, DASH was performed with prerequisite training of the American College of Surgeons Ultrasound for Surgeons Basic Course. Clinical evidence of hernia, results of DASH examination, and radiologist documentation of incisional hernia were compared with the gold standard of surgeon-interpreted CT. Testing characteristics of sensitivity and specificity were compared and predictive values were calculated. Inter-rater reliability was performed by comparing DASH results in a subgroup of patients with 3 different evaluators. There were 181 patients enrolled, with a mean age of 54 years, and 68% were women. In patients in whom hernias were identified, the mean hernia size was 44.6 cm(2) (range 0.2 to 468.3 cm(2)). The DASH examination showed high sensitivity (98%) and specificity (88%). Hernia prevalence was 55% in this population, resulting in positive and negative predictive values of 91% and 97%, respectively. Four patients had clinically detectable hernias that were not seen on CT but were discovered with DASH. Inter-rater reliability for DASH was high, with an observed intraclass correlation coefficient of 0.79. The DASH examination is an accurate alternative to CT scan for diagnosing abdominal wall hernias, with additional benefits of no radiation exposure and instant bedside interpretation. The use of DASH to detect hernia recurrence can greatly facilitate long-term follow-up of hernia patients.

Nationwide Prevalence of Groin Hernia Repair

IntroductionGroin hernia repair is a commonly performed surgical procedure in the western world but large-scaled epidemiologic data are sparse. Large-scale data on the occurrence of groin hernia repair may provide further understanding to the pathophysiology of groin hernia development. This study was undertaken to investigate the age and gender dependent prevalence of groin hernia repair.MethodsIn a nationwide register-based study, using data from the Civil Registration System covering all Danish citizens, we established a population-based cohort of all people living in Denmark on December 31st, 2010. Within this population all groin hernia repairs during the past 5 years were identified using data from the ICD 10th edition in the Danish National Hospital Register.ResultsThe study population covered n = 5,639,885 persons. During the five years study period 46,717 groin hernia repairs were performed (88.6% males, 11.4% females). Inguinal hernias comprised 97% of groin hernia repairs (90.2% males, 9.8% females) and femoral hernias 3% of groin hernia repairs (29.8% males, 70.2% females). Patients between 0–5 years and 75–80 years constituted the two dominant groups for inguinal hernia repair. In contrast, the age-specific prevalence of femoral hernia repair increased steadily throughout life peaking at age 80–90 years in both men and women.ConclusionThe age distribution of inguinal hernia repair is bimodal peaking at early childhood and old age, whereas the prevalence of femoral hernia repair increased steadily throughout life. This information can be used to formulate new hypotheses regarding disease etiology with regard to age and gender specifications.

Role of conventional radiology and MRi defecography of pelvic floor hernias

BackgroundPurpose of the study is to define the role of conventional radiology and MRI in the evaluation of pelvic floor hernias in female pelvic floor disorders.MethodsA MEDLINE and PubMed search was performed for journals before March 2013 with MeSH major terms 'MR Defecography' and 'pelvic floor hernias'.ResultsThe prevalence of pelvic floor hernias at conventional radiology was higher if compared with that at MRI. Concerning the hernia content, there were significantly more enteroceles and sigmoidoceles on conventional radiology than on MRI, whereas, in relation to the hernia development modalities, the prevalence of elytroceles, edroceles, and Douglas' hernias at conventional radiology was significantly higher than that at MRI.ConclusionsMRI shows lower sensitivity than conventional radiology in the detection of pelvic floor hernias development. The less-invasive MRI may have a role in a better evaluation of the entire pelvic anatomy and pelvic organ interaction especially in patients with multicompartmental defects, planned for surgery.

Incidence of Incisional Hernia After Open and Laparoscopic Colorectal Cancer Resection

ObjectivesTo determine the incidence of incisional hernia in patients subjected to colorectal cancer surgery. To analyse the individual risk factors and to determine which patients would benefit more from the use of prophylactic measures. Patients and methodsA retrospective study was performed on the demographic and surgical data, as well as the complications, risk factors and outcomes of all patients subjected to colorectal cancer surgery in the period between January 2006 and September 2008. The diagnosis of incisional hernia was made by means of physical examination or by a review of the follow up CT scan. ResultsA total of 338 patients were reviewed (249 laparotomy and 89 laparoscopy). After a median follow-up of 19.7 months, 87 patients (25.7%) were diagnosed with incisional hernia by a physical examination. The CT scan enabled 48 hernias (14.2%) not detected clinically. The incisional hernia rate was 39.9% (135 patients). There were no significant differences between patients subjected to laparotomy (40.9%) or laparoscopy (37.1%). The incisional hernia rate in overweight patients (BMI≥25kg/m2) was 51.3% compared to 31.1% in patients with normal weight (P=.02). Post-surgical complications (P=.007), surgical wound infections (P=.04), and further surgery during the post-operative period (P<.0001), were also associated with a higher incidence of incisional hernia. ConclusionThe prevalence of incisional hernia after colorectal cancer resection is higher than expected (41%). Patients with a BMI greater than 25kg/m2, and those who require further surgery are candidates to receive a prophylactic mesh.

Biologic mesh use practice patterns in abdominal wall reconstruction: a lack of consensus among surgeons

Despite the prevalence of ventral hernias, there is little agreement as to the most appropriate technique or prosthetic to repair these defects. Our objective was to determine biologic mesh practice patterns of reconstructive surgeons with regard to indications, most appropriate technique, choice of prosthetic, and experience with complications. A survey was mailed to 2,000 practicing surgeons. Main outcome measures included surgeon experience with biologic mesh and associated complications. Two hundred and forty (12 %) surgeons responded to the survey. Ten were excluded, as surgeons completing the survey indicated they did not perform ventral hernia repairs or left multiple questions unanswered. Of the 230 included, 93.5 % (n = 215) of responders had experience using biologic mesh. Frequency of biologic graft use in the last year was as follows: low-volume users (<5 times in the last year) 50.7 %; medium-volume users (5-20 times in the last year) 37.3 %; high-volume users (>20 times in the last year) 11.9 %. Indications for biologic mesh use based on wound classifications (clean, clean contaminated, contaminated or dirty) were quite varied and lacked consensus among surgeons (p value < 0.05). The most commonly reported influences for use included personal experience (45 %), literature (28.3 %), and availability (17.2 %). Despite a lack of level 1 evidence, biologic meshes are being used under various wound classifications. Importantly, use in clean and dirty-infected settings may reflect an inappropriate overuse of these expensive materials. To better guide surgeons, prospective, randomized trials should be undertaken to evaluate the short- and long-term outcomes associated with these materials under the various surgical wound classifications.

Increase in gastroesophageal reflux disease symptoms and erosive esophagitis 1 year after laparoscopic sleeve gastrectomy among obese adults

Although laparoscopic sleeve gastrectomy (LSG) is an effective treatment for morbid obesity, the effects of LSG on gastroesophageal reflux disease (GERD) are controversial. This study evaluated the changes of GERD symptoms and erosive esophagitis (EE) in severely obese patients who underwent LSG. Forty-seven severely obese women and 19 severely obese men (mean age of 37.2 ± 12.7 years) who underwent LSG between August 2007 and November 2009 were enrolled. All patients completed the Reflux Disease Questionnaire and underwent esophagogastroduodenoscopy preoperatively and at least 1 year after LSG. The median follow-up period was 12 months (range, 12-21). After surgery, significant decreases were reported in mean body mass index (36.3 ± 4.1 vs. 25.8 ± 2.9 kg/m(2)), mean waist circumference (109.5 ± 12.8 vs. 85.7 ± 9.5 cm), and prevalence of metabolic syndrome (54.5 vs. 7.6 %; P < 0.001 for both). Conversely, a significant increase was observed in the prevalence of GERD symptoms (12.1 vs. 47 %) and EE (16.7 vs. 66.7 %) after LSG (P < 0.001 for both). The prevalence of hiatal hernias also increased significantly (6.1 vs. 27.3 %; P < 0.001) after LSG, and it was significantly higher in patients with than those without EE after LSG (9.1 vs. 36.4 %, respectively; P = 0.02). Although LSG can achieve significant weight loss and improvement of comorbidities in severely obese patients, the prevalence and severity of GERD symptoms and EE increase after the operation. The occurrence of EE after LSG is related to the presence of a hiatal hernia after the operation.

Characterizing the Global Burden of Surgical Disease: A Method to Estimate Inguinal Hernia Epidemiology in Ghana

Surgical conditions represent an immense yet underrecognized source of disease burden globally. Characterizing the burden of surgical disease has been defined as a priority research agenda in global surgery. Little is known about the epidemiology of inguinal hernia, a common easily treatable surgical condition, in resource-poor settings. Using data from the National Health and Nutrition Examination Survey prospective cohort study of inguinal hernia, we created a method to estimate hernia epidemiology in Ghana. We calculated inguinal hernia incidence and prevalence using Ghanaian demographic data and projected hernia prevalence under three surgical rate and hernia incidence scenarios. Disability adjusted life-years (DALYs) associated with inguinal hernia along with costs for surgical repair were estimated. According to this approach, the prevalence of inguinal hernia in the Ghanaian general population is 3.15% (range 2.79-3.50%). Symptomatic hernias number 530,082 (range 469,501-588,980). The annual incidence of symptomatic hernias is 210 (range 186-233) per 100,000 population. At the estimated Ghanaian hernia repair rate of 30 per 100,000, a backlog of 1 million hernias in need of repair develop over 10 years. The cost of repairing all symptomatic hernias in Ghana is estimated at US $53 million, and US $106 million would be required to eliminate hernias over a 10-year period. Nearly 5 million DALYs would be averted with the repair of prevalent cases of symptomatic hernia in Ghana. Data generated by our method indicate the extent to which Ghana lacks the surgical capacity to address its significant inguinal hernia disease burden. This approach provides a simple framework for calculating inguinal hernia epidemiology in resource-poor settings that may be used for advocacy and program planning in multiple country contexts.

Possible impact of the “yellow card” antimicrobial scheme on meat inspection lesions in Danish finisher pigs

In 2010, the “yellow card scheme” which was adopted by the Danish Veterinary and Food Administration imposed restrictions on pig farmers who used more antimicrobials than twice the average.To study the potential impact on pig health, we looked into antimicrobial consumption and vaccine use data from the monitoring programme Vetstat, covering all treatments conducted on Danish pigs between January 2010 and July 2011. The decrease in antimicrobial consumption was pronounced for all age groups (sows/piglets, weaners and finishers) treated for either gastro-intestinal or respiratory disease. Evaluated over 12 months, use of vaccines increased in general: PCV2-related infections (+31%), gastro-intestinal disease (27%), respiratory infections (21%) whereas use of vaccines against other infections remained almost constant (−18%).Data from meat inspection of finisher pigs from before and after introduction of the scheme were compared. This included 1.7 million finisher pigs originating from 2765 pig farms, slaughtered on one large Danish abattoir and covered the first 9 weeks in 2010 and 2011, respectively. Nine lesions of chronic nature and infectious origin and the code “condemned” were selected. The prevalence of these lesions was calculated. Logistic regression models with year and week as explanatory variables were used to identify whether the prevalence of a lesion changed from 2010 to 2011. Possible clustering due to correlation within herds and between weekly shipments of animals originating from the same herd was taken into account in the models.The most common lesion seen was chronic pleuritis (∼23%) while the other lesions occurred less-commonly (<1%). For osteomyelitis, pleuritis, chronic arthritis and condemnation, no differences were observed between the 2 years. The prevalence of chronic peritonitis (OR=1.5), umbilical hernia (OR=1.2) and chronic enteritis (OR=1.2) were statistically higher in 2011 compared to 2010, whereas it was lower for tail bite infection (OR=0.6), chronic pericarditis (OR=0.6), and chronic pneumonia (OR=0.7) (P<0.001). Moreover, in the condemned carcasses, chronic pneumonia plummeted as a lesion found in 2011 compared to 2010 (OR=0.07, P<0.0001). Our results indicate that marked reduction in use of antimicrobials is associated with a short-term increase in the prevalence of specific lesions found during meat inspection and higher coverage of vaccines against respiratory diseases might impact the prevalence of chronic pneumonia positively. Other factors that impact on pig health were not included in the study. Moreover, effect of productivity was not evaluated.

Correlation of the gastroesophageal flap valve grade with the surgery rate in patients with gastroesophageal reflux disease

The importance of endoscopic evaluation and grading of the gastroesophageal flap valve (GEFV) in patients with gastroesophageal reflux disease (GERD) was previously demonstrated with increased acid exposure and high grades of esophagitis in those with high-grade valves. On the other hand, no data exist on the relationship between GEFV appearance and surgical rate. For 453 patients with symptoms suggestive of GERD, GEFV grading and 24-h ambulatory pH monitoring were performed. Surgery was performed for 82 of these patients who failed medical management or had disease complications. The GEFV grade 4 patients were younger than the patients with normal GEFV (grades 1 [p = 0.017] and 2 [p < 0.001]) and showed significant male predominance. The prevalence of hiatal hernia, the degree of esophageal acid exposure, and the prevalence and degree of erosive esophagitis significantly increased with GEFV grade (p < 0.001 for all). No GEFV grade 1 patients underwent surgery compared with 4.9 % of the grade 2 patients, 20.5 % of the grade 3 patients, and 63.6 % of the grade 4 patients who had surgery for various indications (p < 0.001). Esophagogastric opening estimated by endoscopic grading of the GEFV was strongly correlated with surgery rate in GERD patients. In particular, patients with grade 4 valves showed the highest rates of erosive esophagitis and axial hiatal hernia and frequently underwent surgery for either failed medical management or disease complications.

Opinion. The preoperative role of herniography: reappraising a forgotten technique?

The purpose of the Journal of the Belgian Society of Radiology is the publication of articles dealing with diagnostic and interventional radiology, related imaging techniques, allied sciences, and continuing education

Atypical Symptoms in Patients With Gastroesophageal Reflux Disease

Background/AimsAtypical symptoms are common in gastroesophageal reflux disease (GERD). Patients with non-erosive reflux disease (NERD) and erosive reflux disease (ERD) exhibit different clinical characteristics and responses to acid suppression treatment. We aimed to compare atypical characteristics in patients with NERD and ERD. We also investigated the presence of histological esophagitis in patients with NERD and ERD.MethodsEligible patients completed a questionnaire regarding reflux symptoms and concomitant atypical symptoms. Endoscopic biopsies with histological examination were performed.ResultsOf the 210 patients with GERD, 90 patients with ERD and 120 patients with NERD were studied. ERD patients were characterized by higher prevalence of hiatal hernia (P = 0.001) and smoking (P = 0.047). The prevalence of GERD was greater in the age group between 41 and 60 years regardless of endoscopic finding. There was no difference in the prevalence of atypical symptoms or histological esophagitis between NERD and ERD. In all subjects, heartburn was associated with dysphagia (r = 0.16, P = 0.01), dyspepsia (r = 0.22, P = 0.008) and hiccup (r = 0.19, P = 0.003), whereas acid regurgitation was associated with dyspepsia (r = 0.21, P = 0.014), belching (r = 0.15, P = 0.018) and hiccup (r = 0.19, P = 0.002).ConclusionsAtypical symptoms did not correlate with the presence of histological esophagitis. Atypical symptoms were equally prevalent in patients with NERD and ERD. The existence of atypical symptoms appears to be associated with the presence of typical reflux symptoms irrespective of endoscopic and histological reflux esophagitis.

Elevada incidencia de hernia incisional tras resección abierta y laparoscópica por cáncer colorrectal

ObjectivesTo determine the incidence of incisional hernia in patients subjected to colorectal cancer surgery. To analyse the individual risk factors and to determine which patients would benefit more from the use of prophylactic measures. Patients and methodsA retrospective study was performed on the demographic and surgical data, as well as the complications, risk factors and outcomes of all patients subjected to colorectal cancer surgery in the period between January 2006 and September 2008. The diagnosis of incisional hernia was made by means of physical examination or by a review of the follow up CT scan. ResultsA total of 338 patients were reviewed (249 laparotomy and 89 laparoscopy). After a median follow-up of 19.7 months, 87 patients (25.7%) were diagnosed with incisional hernia by a physical examination. The CT scan enabled 48 hernias (14.2%) not detected clinically. The incisional hernia rate was 39.9% (135 patients). There were no significant differences between patients subjected to laparotomy (40.9%) or laparoscopy (37.1%). The incisional hernia rate in overweight patients (BMI ≥ 25 Kg/m2), was 51.3% compared to 31.1% in patients with normal weight (P=.02). Post-surgical complications (P=.007), surgical wound infections (P=.04), and further surgery during the post-operative period (P<.0001), was also associated with a higher incidence of incisional hernia. ConclusionThe prevalence of incisional hernia after colorectal cancer resection is higher than expected (39,9%). Patients with a BMI greater than 25 kg/m2, and those who require further surgery are candidates to receive a prophylactic mesh.

Tu1151 Racial Differences in Prevalence of Hiatal Hernia and Esophageal Mucosal Injury: Results From a Large Prospective GERD Cohort

Tu1151 Racial Differences in Prevalence of Hiatal Hernia and Esophageal Mucosal Injury: Results From a Large Prospective GERD Cohort

Esophageal manometry findings and degree of acid exposure in short and long Barrett's esophagus

Barrett's esophagus (BE) is characterized by intestinal metaplasia in the distal esophagus and is classified as short-segment (<3 cm - SSBE) or long-segment (>3 cm - LSSBE). It is suggested that LSSBE is associated with more severe esophageal motor abnormalities and increased acid exposure time than SSBE. To evaluate the prevalence of esophageal manometriy abnormalities and acid exposure times in patients with SSBE and LSSBE. Barrett's esophagus patients identified by upper endoscopy and confirmed by histopathology were, retrospectively, reviewed and divided into two groups: SSBE and LSBE. Demographic data, symptom duration, prevalence of hiatal hernia, lower esophagus sphincter basal pressure, prevalence of esophageal body abnormalities and acid exposure times were evaluated. Forty-six patients with SSBE (24 males - 52.2%, mean age of 55.2 years) and 28 patients with LSBE (18 males - 64.3%, mean age of 50.5 years). Mean symptom duration was 9.9 years for SSBE and 12.9 years for LSSBE. Hiatal hernia was present in 84.2% of SSBE, 96.3% of LSBE; average lower esophagus sphincter pressure in SSBE 9.15 mm Hg, in LSBE 6.99 mm Hg; lower esophagus sphincter hypotension in SSBE was 65.9%, in LSSBE 82.1%; aperistalsis in SSBE 6.5%, LSSBE 3.6%; mild/moderate ineffective esophageal motility in SSBE 34.8%, LSBE 46.4%; severe moderate ineffective esophageal motility in SSBE 10.9%, LSBE 7,1%; nutcracker esophagus/segmental nutcracker esophagus in SSBE 8.6%, LSBE 0%; normal body in SSBE 39.1%, in LSBE 42.9%, no statistical difference for any of these values (P<0.05). Average % total time pH<4 in SSBE 9.12, LSBE 17.27 (P<0.000); % time pH<4 upright in SSBE 11.91; LSBE 24.29 (P=0.003); % time pH<4 supine in SSBE 10.86, LSBE 33.26 (P = 0.000). There was no difference between the prevalence of motor disorders in patients with SSBE and LSSBE. Acid reflux in upright and supine positions was more intense in LSBE.

The Prevalence and Extent of Gastroesophageal Reflux Disease Correlates to the Type of Lung Transplantation

Evidence is increasingly convincing that lung transplantation is a risk factor of gastroesophageal reflux disease (GERD). However, it is still not known if the type of lung transplant (unilateral, bilateral, or retransplant) plays a role in the pathogenesis of GERD. The records of 61 lung transplant patients who underwent esophageal function tests between September 2008 and May 2010, were retrospectively reviewed. These patients were divided into 3 groups based on the type of lung transplant they received: unilateral (n=25); bilateral (n=30), and retransplant (n=6). Among these groups we compared: (1) the demographic characteristics (eg, sex, age, race, and body mass index); (2) the presence of Barrett esophagus, delayed gastric emptying, and hiatal hernia; and (3) the esophageal manometric and pH-metric profile. Distal and proximal reflux were more prevalent in patients with bilateral transplant or retransplant and less prevalent in patients after unilateral transplant, regardless of the cause of their lung disease. The prevalence of hiatal hernia, Barrett esophagus, and the manometric profile were similar in all groups of patients. Although our data show a discrepancy in prevalence of GERD in patients with different types of lung transplantation, we cannot determine the exact cause for these findings from this study. We speculate that the extent of dissection during the transplant places the patients at risk for GERD. On the basis of the results of this study, a higher level of suspicion of GERD should be held in patients after bilateral or retransplantation.