The Construction Of The Diagnostic Criteria Of Sliding Hiatus Hernia Using High-resolution Manometry

Background and aims：The sliding hiatal hernia (sliding hiatus hernia, SHH), is also known as the refoldinghiatal hernia, pointing that abdominal esophagus, esophagogastric junction and part of thebody of stomach into the chest but sometimes it can be restored to the abdomen in situ, is themost common form of hiatal hernia (hiatal hernia, HH), accounting for about70%~90%ofHH.SHH can occur in all age groups, but the gradual increase in the incidence ofmiddle-aged, in particular, to a higher incidence of older people.The of SHH is mainlydependent on x-ray barium meal examination and gastroscopy. In recent years, medicalexperts proposed a more intuitive and accurate way(the high-resolution manometry) toexamination SHH. The high-resolution manometry, simultaneous monitoring of pressurechanges from the throat to the abdomen, one-off show the pharynx to the stomach pressurewell display the separation of high pressure zone about the LES and diaphragm feet,not likethe barium meal examination or gastroscopy because that the barium swallow or cheercausing esophageal dilatation, shortening which may cause short segment hiatal herniacaused by human. SHH diagnosis with high specificity, but still no reports of the bulk ofcases.As the technology of high-resolution manometry in our country at a research stage, verylittle about its application research in the gastrointestinal tract. There is no high-resolutionmanometry system in the application of the sliding hiatal hernia. The purpose of this study isto explore a sliding hiatal hernia in a variety of high-resolution esophageal manometrymanometry data, the development of high-resolution esophageal manometry for thediagnosis of sliding hiatal hernia diagnostic criteria, evaluation of the sliding type hiatus forthe authenticity and reliability of the diagnosis of sliding hiatal hernia, hernia, sliding hiatalhernia in the clinical application of further foundation.Methods：The hiatal hernia patients was examinationed by upper gastrointestinal endoscopy andX-ray examination in Outpatient. Collecting by endoscopy and (or) X-ray diagnosis of hiatalhernia patients for the experimental group, a total of47cases of concurrent With high-resolution manometry,record the resting pressure of LES, the residual pressure ofLES,the distance between the lower edge of the LES and the diaphragm feet,the LESrelaxation rate, failure rate,the resting tension of diaphragm feet, the average amplitude, theaverage time of the amplitude and the esophagus paragraphs peristaltic contraction pressuredata on the upper edge of the LES3,7,11cm. Healthy individuals as control group, for atotal of33cases, and concurrent esophageal manometry and record the data.Results：1. Mainly of47cases of SHH in patients with clinical symptoms are heartburn, acidreflux and substernal chest pain.2. Endoscopy and (or) X-ray barium meal examination which diagnosis47case ofSHH patients.they are found the separation of two high pressure zones between LES anddiaphragm feet.The LES-diaphragm distance≥1cm accounted for87%of all SHH patients(41/47),where separation is more obvious (≥2cm) accounted for34%of all SHH patients(16/47).3. HRM detection rate of82.98%(39/47), specificity was100%(33/33); gastroscopyconfirmed for55.32%(26/47); barium meal X-ray diagnosis was44.68%(21/47) of whichwere diagnosed by endoscopy and X-ray barium meal to17patients, accounting for36.17%(17/47).4. SHH patients except the chang of LES-diaphragm distance indicators, the otherindicators having a corresponding change but both of the average amplitude and the averagetime of the amplitude are not statistically significant.Conclusions：High-resolution manometry for diagnosis the sliding hiatal hernia with higherspecificitythan endoscopy, X-ray barium meal examination.