title: Hiatus hernia in healthy volunteers is associated with intrasphincteric reflux and cardiac mucosal lengthening without traditional reflux.
abstract: Hiatus hernia (HH) is a key mediator of gastro-oesophageal reflux disease but little is known about its significance in the general population. We studied the structure and function of the gastro-oesophageal junction in healthy volunteers with and without HH.
  
  
  
  We compared 15 volunteers with HH, detected by endoscopy or MRI scan, but without gastro-oesophageal reflux disease with 15 controls matched for age, gender and body weight. Jumbo biopsies were taken across the squamocolumnar junction (SCJ). High-resolution pH metry (12 sensors) and manometry (36 sensors) were performed upright and supine, before and after a meal. The SCJ was marked with an endoscopically placed clip and visualised fluoroscopically.
  
  
  
  Cardiac mucosa was longer in volunteers with HH (3.5 vs 2.5 mm, p=0.01). There was no excessive acid reflux 5 cm above the upper border of the lower oesophageal sphincter (LOS) in either group but those with HH had short segment reflux 11 mm above the pH transition point after the meal when supine (pH<4 for 5.5% vs 0.3% of time, p=0.01). The SCJ and pH transition point were proximally displaced within the gastro-oesophageal junction in those with HH versus controls (p<0.05). The pH transition point was proximal to the peak LOS pressure point in HH subjects but distal to it in controls after the meal (p<0.05). When supine, the postprandial pH transition point crossed the SCJ in those with HH (p=0.03).
  
  
  
  Healthy volunteers with HH have increased intrasphincteric reflux and lengthening of cardiac mucosa in the absence of traditional transsphincteric reflux.
authors.affiliation: Section of Gastroenterology, ICAMS, University of Glasgow, Glasgow, UK.
authors.forename: Elaine V
authors.initials: EV
authors.lastname: Robertson
authors.affiliation: Section of Gastroenterology, ICAMS, University of Glasgow, Glasgow, UK.
authors.forename: Mohammad H
authors.initials: MH
authors.lastname: Derakhshan
authors.affiliation: Section of Gastroenterology, ICAMS, University of Glasgow, Glasgow, UK.
authors.forename: Angela A
authors.initials: AA
authors.lastname: Wirz
authors.affiliation: Section of Gastroenterology, ICAMS, University of Glasgow, Glasgow, UK.
authors.forename: David R
authors.initials: DR
authors.lastname: Mitchell
authors.affiliation: University Department of Pathology, University of Glasgow, Glasgow, UK.
authors.forename: James J
authors.initials: JJ
authors.lastname: Going
authors.affiliation: Section of Gastroenterology, ICAMS, University of Glasgow, Glasgow, UK.
authors.forename: Andrew W
authors.initials: AW
authors.lastname: Kelman
authors.affiliation: Department of Radiology, Queen Elizabeth University Hospital, Glasgow, UK.
authors.forename: Stuart A
authors.initials: SA
authors.lastname: Ballantyne
authors.affiliation: Section of Gastroenterology, ICAMS, University of Glasgow, Glasgow, UK.
authors.forename: Kenneth E L
authors.initials: KEL
authors.lastname: McColl
mesh_terms: D000328:Adult; D000368:Aged; D001706:Biopsy; D002299:Cardia / Q000000981:diagnostic imaging* / Q000473:pathology; D016022:Case-Control Studies; D016099:Endoscopy, Gastrointestinal; D049630:Esophageal Sphincter, Lower / Q000000981:diagnostic imaging* / Q000473:pathology; D004943:Esophagogastric Junction / Q000000981:diagnostic imaging* / Q000473:pathology; D005260:Female; D005471:Fluoroscopy; D005745:Gastric Acidity Determination; D005764:Gastroesophageal Reflux / Q000209:etiology*; D064368:Healthy Volunteers; D006551:Hernia, Hiatal / Q000150:complications*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008365:Manometry; D008875:Middle Aged; D009092:Mucous Membrane / Q000000981:diagnostic imaging* / Q000473:pathology
keywords: GASTROESOPHAGEAL REFLUX DISEASE; GASTROINTESTINAL MOTILITY; HIATAL HERNIA