The Cause of Dysphagia in Uncomplicated Sliding Hiatal Hernia and its Relief by Hiatal Herniorrhaphy

Authors:
  • TDTOM R. DeMEESTER
    TOM R. DeMEESTER
  • MOMasaaki Oka
    Masaaki Oka
  • CBChris S. Ball
    Chris S. Ball
  • HSHubert J. Stein
    Hubert J. Stein
  • CKChoong B. Kim
    Choong B. Kim
  • SCShih-Chuan Cheng
    Shih-Chuan Cheng
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Abstract
Patients with an uncomplicated sliding hiatal hernia frequently experience dysphagia. The present study shows, using video barium constrast esophagograms, that the cause of dysphagia in 60% of these patients is an obstruction to the passage of the swallowed bolus by diaphragmatic impingement on the herniated stomach. Manometrically this was reflected by a double-hump high pressure zone (HPZ) at the gastroesophageal junction, and specifically to the length and amplitude of the distal HPZ and the lengh of the intervening segment between the two HPZs. The former represents the degree of the diaphragmatic impingement on the herniated stomach and the latter the size of the supradiaphragmatic herniated stomach. Surgical reduction of the hernia resulted in relief of dysphagia in 91% of the patients.

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