title: Effects of large hiatal hernias on esophageal peristalsis.
abstract: OBJECTIVE
  Anatomic changes induced by large hiatal hernia may alter esophageal pressure topography measurements made during high-resolution manometry.
  
  
  METHODS
  Retrospective study.
  
  
  METHODS
  Single-institution tertiary hospital.
  
  
  METHODS
  Ninety patients with large (>5 cm) hiatal hernias on endoscopy were compared with a control group of 46 patients without hernia selected from the same database of 2000 consecutive clinical high-resolution manometry studies.
  
  
  METHODS
  High-resolution manometry with at least 7 evaluable swallows for analysis.
  
  
  METHODS
  Esophageal pressure topography was analyzed for lower esophageal sphincter pressure, distal contractile integral, contraction amplitude, contractile front velocity, and distal latency time. Esophageal length was measured on esophageal pressure topography from the distal border of the upper esophageal sphincter to the proximal border of the lower esophageal sphincter. Esophageal pressure topography diagnosis was based on the Chicago Classification.
  
  
  RESULTS
  The manometry catheter was coiled in the hernia and did not traverse the diaphragm in 44 patients (49%) with large hernia. Patients with large hernias had lower average lower esophageal sphincter pressures, a lower distal contractile integral, slower contractile front velocity, and shorter distal latency time than patients without hernia. They also exhibited a shorter mean esophageal length. However, the distribution of peristaltic abnormalities was not different in patients with and without large hernia.
  
  
  CONCLUSIONS
  Patients with large hernias had an alteration of esophageal pressure topography measurements and a shortened esophagus. However, the distribution of peristaltic disorders was unaffected by the presence of hernia.
authors.affiliation: Northwestern University, Feinberg School of Medicine, Department of Medicine, Chicago, IL 60611-2951, USA.
authors.forename: Sabine
authors.initials: S
authors.lastname: Roman
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Kahrilas
authors.forename: Leila
authors.initials: L
authors.lastname: Kia
authors.forename: Daniel
authors.initials: D
authors.lastname: Luger
authors.forename: Nathaniel
authors.initials: N
authors.lastname: Soper
authors.forename: John E
authors.initials: JE
authors.lastname: Pandolfino
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D016099:Endoscopy, Gastrointestinal; D005260:Female; D006551:Hernia, Hiatal / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008365:Manometry; D008875:Middle Aged; D010528:Peristalsis / Q000502:physiology*; D012189:Retrospective Studies; D018709:Statistics, Nonparametric