Журнал "Гастроэнтерология" Том 56, №3, 2022
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The tone of anatomical narrowings of the esophagogastroduodenal zone in patients with hiatal hernia
Авторы: O.O. Halinskyi, N.V. Prolom, A.M. Halinska
SI “Institute of Gastroenterology of the National Academy of Medical Sciences of Ukraine”, Dnipro, Ukraine
Рубрики: Гастроэнтерология
Разделы: Медицинские форумы
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The aim of the article: to evaluate the tone of anatomical narrowings of the esophagogastroduodenal zone in patients with hiatal hernia (HH) using pneumoballoon manometry.
Materials and methods. The study was conducted in 83 patients with HH, divided by types: axial (n = 64), paraesophageal (n = 8), mixed (n = 11). The tone of anatomical constrictions was measured using the method of endoscopic pneumoballoon manometry. Pressure indicators were calculated in millimeters of mercury column as the relative value of the pressure peak during the passage of the balloon through the sphincter zone from the bottom up, excluding the background level in the lower part of the alimentary canal. An Art-line AS-00013 sensor was used, connected to a neurosurgical monitor-01 digital signal processing unit. Quantitative differences were evaluated by the method of pairwise comparisons, the data were considered to be significantly different with an error of less than 0.05.
Results. According to the results of the study, it was established that in patients with HH, the average pressure increase in the balloon during passage through the zone of the lower esophageal sphincter (LES) was (11.12 ± 3.25) mm Hg, which is 36.33 % (p < 0.05) lower compared to the norm, while when passing the pyloroduodenal sphincter (PDS), (32.38 ± 2.72) mm Hg, which is 2.9 times more (p < 0.01) compared to the area of the LES, and 1.9 times higher than the norm (p < 0.05). In patients with axial HH, the pressure when passing through the zone of the LES was (12.95 ± 3.02) mm Hg, while the pressure in the area of the PDS was 2.5 times higher (p < 0.05), being at the level of (32.73 ± 3.32) mm Hg In patients with paraesophageal HH, the pressure in the balloon during passage of the LES was (8.06 ± 3.64) mm Hg, as for the pressure in the area of the PDS, it was at the level of (33.95 ± 6.67) mm Hg, which is 1.9 times higher than the norm (p < 0.05). In patients with mixed HH during the study, no resistance to the passage of the balloon was found in the area of the entrance opening of the stomach, while in the area of the PDS, an increase in the pressure in the balloon was noted to the level of (29.99 ± 11.13) mm Hg relative to the pressure in the balloon placed in the cavity of the bulb of the duodenum.
Conclusions. In patients HH, a decrease in tone in the area of the LES was found on average by 36 % (p < 0.05), and the pressure in the balloon during the passage of the area of the PDS was 2.9 times higher than during passage of the area LES. The lowest pressure ((0.16 ± 0.16) mm Hg) in the area of the LES was in the group of patients with mixed hernias of the esophageal opening. Statistically significant differences between pressure indicators in the area of the LES in the groups of patients with axial and paraesophageal hernias were not found.