Endoskopik Hiatal Herni Tespit Edilen Hastaların Klinikopatolojik Özelliklerinin Karşılaştırılması

Year 2024, Volume: 2 Issue: 1, 32 - 36, 29.02.2024

Aysun Yakut Murat Aladag

https://doi.org/10.61845/agrimedical.1349294

Abstract

Amaç: Hiatal herni (HH); abdominal kompartmandaki mide gibi organ ve dokuların göğüs boşluğuna yerdeğiştirmesidir. HH özofagus ile diyafram arasındaki oryantasyona göre sınıflandırılır. Hastalar genellikle asemptomatik olup bazen gastrik reflü, mide bulantısı, şişkinlik, retrosternal ağrı, gastroözofagial kanama ve disfaji gibi birçok klinikle prezente olabilir. Bu çalışmada; HH olan hastaların, klinik prezentasyonunu değerlendirmek, endoskopik olarak tanısını sınıflandırarak koymak ve tedavide medikal ve invaziv olarak neler yapılabileceğini vurgulamak istedik. Gereç ve Yöntem: Bu çalışma 2021-2022 tarihleri arasında endoskopi ünitemize başvurmuş 565 hastanın gastroskopisinde HH tespit edildiği retrospektif bir çalışmadır. Gastroskopisinde HH`si olmayan ve kardia gevşekliği olan hastalar çalışmaya dahil edilmedi. Hastaların demografik özellikleri, şikayetleri, endoskopik bulguları, patolojik bulguları ve takipleri hastane veri tabanından kaydedildi. Bu veriler değerlendirilirken, istatistiksel analizler için NCSS (Number Cruncher Statistical System) 2020 Statistical Software (NCSS LLC, Kaysville, Utah, USA) programı kullanıldı. Bulgular: Çalışmamıza katılan 565 hastanın %40,2’sinin (n=227) kadın, %59,8’inin (n=338) erkekti. HH olanların yaşları 16 ile 103 arasında değişmekte olup, ortalama yaş 49,31±17,08 olarak belirlenmiştir. HH olan hastalarda sıklıkla Tip I sliding tipte HH tespit edilmiştir. Semptomatik hastalarda genellikle reflü şikayeti olup proton pompa inhibitörleri, anti-asitler, aljinat gibi ilaçlarla sıklıkla semptomatik iyileşme sağlandığı tespit edilmiştir. Sonuç: HH genellikle asemptomatik olmakla birlikte, semptomatik vakalarda ciddi klinik bir sorundur. Tip I sliding HH sıklıkla tespit edilir, bu hastalar genellikle yaşam tarzı değişikliği ve medikal tedavi ile semptomatik iyileşme sağlamaktadır. Ancak tedaviye dirençli ve komplike hastalarda endoskopik ve\veya cerrahi maniplasyonlar ile semptomatik iyileşme sağlanmaktadır.

Keywords

Hiatal herni, Semptomlar, Sınıflama, Tedavi

The Comparison of Clinicopathological Features of Patients with Hiatal Hernia Detected Endoscopically

Abstract

Aim: Hiatal hernia (HH) is the displacement of organs and tissues in the abdominal compartment, such as the stomach, into the chest cavity. HH is classified according to the orientation between the esophagus and diaphragm. Patients are usually asymptomatic and may sometimes present with many symptoms, such as gastric reflux, nausea, bloating, retrosternal pain, gastroesophageal bleeding, and dysphagia. In this study, we aimed to evaluate the clinical presentation of patients with HH, classify and diagnose endoscopically, and emphasize what can be achieved medically and invasively in the treatment. Material and Method: This was a retrospective study in which HH was detected in the gastroscopy of 565 patients who applied to our endoscopy unit between 2021- 2022. The study did not include patients without HH and cardia laxity on gastroscopy. The demographic characteristics, complaints, endoscopic findings, pathological findings, and follow-ups of the patients were recorded in the hospital database. While evaluating these data, the NCSS (Number Cruncher Statistical System) 2020 Statistical Software (NCSS LLC, Kaysville, Utah, USA) program was used for the statistical analysis. Results: Of the 565 patients in our study, 40.2% (n = 227) were female and 59.8% (n = 338) were male. The ages of those with HH ranged from 16 to 103 years, and the mean age was determined to be 49.31±17.08. Type I sliding type HH was frequently detected in patients with HH. Symptomatic patients usually complain of reflux, and it has been determined that symptomatic improvement was often achieved with medications such as proton pump inhibitors, antacids, and alginate. Conclusion: Although HH is generally asymptomatic, it may be a severe clinical problem in symptomatic cases. Type I sliding HH is frequently detected, and these patients usually achieve symptomatic improvement with lifestyle changes and medical treatment. However, in treatment-resistant and complicated patients, symptomatic improvement is achieved with endoscopic and surgical manipulations.

Keywords

Hiatal hernia, Symptoms, Classification, Treatment

References

• Zaman JA, Lidor AO. The optimal approach to symptomatic paraesophageal hernia repair: important technical considerations. Curr Gastroenterol Rep. 2016;18(10):53.
• Hyun JJ, Bak YT. Clinical significance of hiatal hernia. Gut Liver. 2011;5(3):267-77.
• Kavic SM, Segan RD, George IM, Turner PL, Roth JS, Park A. Classification of hiatal hernias using dynamic three-dimensional reconstruction. Surg Innov. 2006;13(1):49-52.
• Ellis FH Jr. Diaphragmatic hiatal hernias. Recognizing and treating the major types. Postgrad Med. 1990;88(1):113-4,117-20,123-4.
• Menon S, Trudgill N. Risk factors in the aetiology of hiatus hernia: a meta-analysis. Eur J Gastroenterol Hepatol. 2011;23(2):133-8.
• Parameswaran R, Ali A, Velmurugan S, Adjepong SE, Sigurdsson A. Laparoscopic repair of large paraesophageal hiatus hernia: quality of life and durability. Surg Endosc. 2006;20(8):1221-4.
• Skinner DB, Belsey RH. Surgical management of esophageal reflux and hiatus hernia. Long-term results with 1,030 patients. J Thorac Cardiovasc Surg. 1967;53(1):33-54.
• Hill LD. Incarcerated paraesophageal hernia. A surgical emergency. Am J Surg. 1973;126(2):286- 91.
• Scheffer RC, Bredenoord AJ, Hebbard GS, Smout AJ, Samsom M. Effect of proximal gastric volume on hiatal hernia. Neurogastroenterol Motil. 2010;22(5):552-556.
• Katkhouda N, Mavor E, Achanta K, et al. Laparoscopic repair of chronic intrathoracic gastric volvulus. Surgery 2000;128(5):784-90.
• Yang X, Li Y, Sun Y, et al. Vonoprazan: A novel and potent alternative in the treatment of acidrelated diseases. Dig Dis Sci. 2018;63(2):302-311.
• Kalapala R, Singla N, Reddy DN. Endoscopic management of gastroesophageal reflux disease: Panacea for proton pump inhibitors dependent/refractory patients. Dig Endosc. 2022;34(4):687- 699.
• Håkansson B, Montgomery M, Cadiere GB, et al. Randomised clinical trial: transoral incisionless fundoplication vs. sham intervention to control chronic GERD. Aliment Pharmacol Ther. 2015;42(11-12):1261-70.
• Rouphael C, Padival R, Sanaka MR, Thota PN. Endoscopic treatments of GERD. Curr Treat Options Gastroenterol. 2018;16(1):58-71.
• Inoue H, Ito H, Ikeda H, et al. Anti-reflux mucosectomy for gastroesophageal reflux disease in the absence of hiatus hernia: a pilot study. Ann Gastroenterol. 2014;27(4):346-351.
• Shimamura Y, Inoue H. Anti-reflux mucosectomy: Can we do better? Dig Endosc. 2020;32(5):736- 738.