In small hiatal hernias, the size of the hernia is variable.
Intermittent complete reduction can be observed with high-resolution manometry as a transition from a double-peak to a single-peak high-pressure zone.
Dr Albert Bredenoord and team from the Netherlands performed prolonged high-resolution manometry in 16 patients.
The patients presented with a small hiatal hernia of about 3 cm.
The team investigated whether intermittent separation of the diaphragm and lower esophageal sphincter favors the occurrence of gastroesophageal reflux disease.
Acid and weakly acidic reflux episodes were detected with pH-impedance monitoring.
The researchers presented the single pressure peak profile, or reduced hernia, for 814 minutes.
|There was no increase in transient lower esophageal sphincter relaxation|
The double peak profile, or unreduced hernia, was present for 626 minutes.
In all patients, both pressure profiles were observed.
The transition rate between the 2 profiles was 8 per hour.
The team noted that more reflux occurred when the lower esophageal sphincter and diaphragm were separated versus the reduced hernia state.
The researchers found that the proportions of acidic reflux episodes during the single and double pressure peaks were similar.
In the 2-pressure-zone state, there was an increase in all reflux mechanisms except transient lower esophageal sphincter relaxation.
Dr Bredenoord's team concluded, “In patients with a small hiatal hernia, intermittent reduction of the hernia occurs frequently.”
“Spatial separation of the diaphragm and lower esophageal sphincter in the nonreduced state results in a 2-fold increase in acidic and weakly acidic reflux due to mechanisms other than transient lower esophageal sphincter relaxation.”