High-resolution manometry features of paraesophageal hernia

Area of Science:

• Gastroenterology
• Esophageal Physiology
• Diagnostic Imaging

Background:

• Paraesophageal hernias (PEH) can cause obstructive symptoms.
• High-resolution manometry (HRM) characteristics of PEH are not well-defined.

Purpose of the Study:

• To characterize the esophageal and gastroesophageal junction (EGJ) motor physiology in patients with PEH using HRM.
• To identify specific HRM findings that may indicate the presence of PEH.

Main Methods:

• HRM studies of 60 PEH patients, 125 axial hernia patients, and 20 healthy controls were analyzed.
• Key metrics including distal contractile integral (DCI), esophageal length, lower esophageal sphincter pressures (LESP), EGJ contractile integral (EGJ-CI), and integrated relaxation pressure (IRP) were extracted.
• Intra-luminal pressures proximal (intrabolus pressure, IBP) and distal (intragastric pressure, IGP) to the EGJ were measured.

Main Results:

• PEH patients exhibited elevated IBP and IGP, and shorter esophageal length compared to axial hernia patients and controls.
• Intrabolus pressure (IBP) was identified as an independent predictor of PEH on multivariate analysis.
• Gastric pressure was higher in PEH subtypes with concurrent axial hernias compared to isolated PEH.

Conclusions:

• Increased luminal pressure upstream and downstream of the EGJ on HRM likely signifies obstructive phenomena in PEH.
• Identification of these pressure changes may aid in the suspicion and diagnosis of PEH.