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


METHODS
Fifty 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.


RESULTS
The 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.


CONCLUSIONS
The presence of HH is correlated with more severe endoscopy findings, and predisposes for severe histological abnormality in cases of NERD.
Gatopoulou
Anthie
A
Endoscopy Unit, Democritus University of Thrace, Dragana, GR-68100 Alexandroupolis, Greece. gatop@otenet.gr <gatop@otenet.gr>
Mimidis
Konstantinos
K
Giatromanolaki
Alexandra
A
Papadopoulos
Vassilios
V
Polychronidis
Alexandros
A
Lyratzopoulos
Nikolaos
N
Sivridis
Efthimios
E
Minopoulos
Georgios
G
D000328:Adult; D001706:Biopsy; D016145:Endoscopy, Digestive System; D005260:Female; D005764:Gastroesophageal Reflux / Q000150:complications* / Q000378:metabolism / Q000473:pathology*; D006003:Glycogen / Q000378:metabolism; D006551:Hernia, Hiatal / Q000150:complications*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D016037:Single-Blind Method
D006003:Glycogen