Gastroesophageal reflux (GERD) refers to the presence of stomach contents in the esophagus. Hiatal hernia is when the stomach moves up into the chest. Many people with hiatal hernia have no symptoms, but others may have heartburn related to gastroesophageal reflux disease, or GERD. Sliding hiatal hernia is a common endoscopic finding with a prevalence that increases KEY WORDS: H. pylori; gastroesophageal reflux disease; hiatus hernia;.
Contact Us What is gastroesophageal reflux? Gastroesophageal reflux or GERDis the presence of stomach contents in the esophagus.
Connecting the Dots: Understanding the Link Between Hiatal Hernia and GERD
A weakened valve between the esophagus and stomach allows gastric contents to irritate the esophagus. GERD affects many people, and usually presents itself as heartburn. In most cases, heartburn can be relieved through diet and lifestyle changes. Six tips to control heartburn Avoid foods and beverages that irritate the esophagus and might further weaken the muscular valve.
These include fried and fatty foods, peppermint, chocolate, alcohol, coffee, citrus fruits and juices, and tomato products.
Lose weight if you are overweight. Elevate your head 6 inches by elevating the head of your bed on blocks or books. Avoid lying down two to three hours after eating. Hiatal hernia does not appear to be the primary cause of abnormal gastroesophageal reflux; its existence may result from functional or anatomic factors that promote excessive reflux. Hiatal hernia may increase the likelihood of LES dysfunction or may affect esophageal clearance and thus permit development or exacerbation of GERD.
Further investigations are needed to clarify this potential relationship [ 1 ]. Evaluation of gastroesophageal reflux Gastroesophageal reflux is often a normal physiologic phenomenon commonly seen when the patient is in supine position. Spencer [ 5 ] first described an esophageal probe used for prolonged pH monitoring in the esophagus in InJohnson and DeMeester [ 6 ] established hour monitoring as a standard measurement for evaluating gastroesophageal reflux.
GERD, Hiatal Hernia, and Heartburn
Total percentage of reflux time at pH less than 4, recorded by an ambulatory recorder through a probe placed in the lower esophagus, is accepted as the most reliable criterion to evaluate abnormal reflux. Reflux episodes occurring at a pH above 4, regardless of their frequency and duration, are categorized as normal. All of above pH measurements are recorded from a probe placed 5 cm above the LES. Many investigators use two probes, one in the lower esophagus and the other in the pharynx. Any reflux episode with a pH lower than 4 from the pharyngeal probe is counted as abnormal, regardless of the length of the reflux event.
However, pharyngeal reflux is not the subject of this question. The following description of the percentage of reflux time and the pH level refers to episodes that occur and were recorded from the probe placed in the lower esophagus. Correlation of hiatal hernia and gastroesophageal reflux The correlation between the presence of hiatal hernia and that of gastroesophageal reflux is controversial. Hiatal hernia is a common radiographic finding. Many patients with hiatal hernia do not have abnormal gastroesophageal reflux, but most patients with reflux disease do have hernias Figures 1 and 2 [ 18 ].
The radiographic detection of reflux esophagitis depends primarily on the endoscopic severity of disease.
GERD, Hiatal Hernia, & Heartburn | Cleveland Clinic
Mild endoscopic esophagitis, depending on the criteria used, is detected poorly by the radiographic examination. However, in the moderate and more severe grades of endoscopic esophagitis i. Mucosal relief film showing thickened and irregular esophageal folds due to reflux esophagitis. Full-column radiograph in same patient demonstrates no stricture; however, the mucosal abnormality is obscurred by the nature of the technique.
Mucosal irregularity and ulceration of the lower esophagus with hiatal hernia. Reflux esophagitis was present at endoscopy showing ulcerations. Double-contrast film of reflux esophagitis showing markedly irregular surface with multiple erosions and ulcerations. Radiographic detection of reflux esophagitis depends also on the thoroughness of the examination and is optimized by the combined use of the full-column, mucosal relief, and double-contrast techniques [ 14 ].
Mild esophagitis is best detected on mucosal relief films as fold thickening and irregularity and on double-contrast views as surface granularity Figures 3 and 4. All three techniques may contribute to diagnosing moderate esophagitis, with fold thickening shown on mucosal relief techniques; surface irregularity, erosions, and ulceration on double-contrast films; and serration of the esophageal contour and limited distensibility on full-column examination.
Borderline esophageal fold thickening, transient irregularity of the esophageal margin due to tertiary contractions are the most common causes of false positive error. Finally, a lower esophageal mucosal ring may mimic an annular peptic stricture. Two views of a peptic stricture arrows located at the tubulovestibular junction.
Esophageal vestibule V and hiatal hernia below the level of the stricture suggesting the presence of Barrett's esophagus, which was seen at endoscopy. Normal upright double-contrast film of the lower esophagus in patient with dysphagia. Prone full-column radiograph in same patient showing an 8 mm annular narrowing not seen on the double-contrast technique. Conclusion The role of the barium esophagogram for evaluation of patients with suspected GERD has been clarified in recent years.
The radiographic examination can assess for hiatal hernia, abnormal esophageal motility, gastroesophageal reflux, and the gross morphologic changes of reflux esophagitis. Hiatal hernia is a common radiographic finding but most of these patients will not be shown to have gastroesophageal reflux nor have signs of reflux esophagitis. Gastroesophageal reflux is detected poorly during the brief fluoroscopic observation time used for the radiologic evaluation of the esophagus; the water siphon test may be more effective in detecting abnormal gastroesophageal reflux but further investigations are needed to reassess its efficacy.