title: Clinical significance of hiatal hernia in the development of gastroesophageal reflux after distal gastrectomy for cancer of the stomach.
abstract: OBJECTIVE
  The relationship between gastroesophageal reflux disease and sliding hernia is controversial, especially following distal partial gastrectomy in patients with gastric cancer. The aim of this study was to examine the relationship between gastroesophageal reflux disease and sliding hernia of the esophagus after distal gastrectomy using the gastroesophageal scintigraphy and endoscopy.
  
  
  METHODS
  Forty-five distal gastrectomy patients diagnosed with cancer of the stomach were studied. Twenty-five patients presented with reflux symptoms, such as heartburn and/or regurgitation and 20 patients exhibited no reflux symptoms. All of the patients were examined by gastroesophageal scintigraphy and their reflux indices were determined. Thirty-eight of the patients underwent upper endoscopy and both sliding hernias and reflux symptoms were classified as mild or severe.
  
  
  RESULTS
  Sliding hernias were diagnosed in all of the subjects and 65.8% of the patients exhibited reflux symptoms. Evidence of endoscopic esophagitis was noted in only 39.5% of the patients. The reflux indices for the mild and severe hernia groups were 5.03 +/- 2.2 and 10.3 +/- 6.4, respectively (P < 0.05). More severely symptomatic esophagitis was prevalent in the severe hernia group in comparison to the mild group (P < 0.05).
  
  
  CONCLUSIONS
  The results suggest that the onset of gastroesophageal reflux after distal gastrectomy is induced by the surgical procedures and that hiatal hernia may be an important factor in the etiology of reflux esophagitis.
authors.affiliation: The Second Department of Surgery, Hyogo College of Medicine, Hyogo, Japan. fujiwa2s@hyo-med.ac.jp
authors.forename: Yoshinori
authors.initials: Y
authors.lastname: Fujiwara
authors.forename: Koji
authors.initials: K
authors.lastname: Nakao
authors.forename: Takashi
authors.initials: T
authors.lastname: Inoue
authors.forename: Kenji
authors.initials: K
authors.lastname: Koishi
authors.forename: Yoshimasa
authors.initials: Y
authors.lastname: Nishio
authors.forename: Ryuichirou
authors.initials: R
authors.lastname: Yagyu
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Nakagawa
authors.forename: Takehira
authors.initials: T
authors.lastname: Yamamura
mesh_terms: D001706:Biopsy; D016099:Endoscopy, Gastrointestinal; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy / Q000009:adverse effects*; D005764:Gastroesophageal Reflux / Q000175:diagnosis / Q000209:etiology*; D006551:Hernia, Hiatal / Q000150:complications* / Q000175:diagnosis / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013274:Stomach Neoplasms / Q000601:surgery*