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Preoperative Diagnostic Workup for GERD and Hiatal Hernia: An Evidence and Experience-Based Approach

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Hiatal Hernia Surgery

Abstract

Gastroesophageal Reflux Disease (GERD) is a very common disorder which affects up to 20% of the population of the Western World [1–5]. The diagnosis of GERD requires more than solely the reflux of gastric contents into the esophagus; indeed, some reflux is normal in all patients. GERD symptoms include the “typical” symptoms of heartburn and regurgitation, together with the “atypical” symptoms of cough, dysphonia, chest pain, epigastric pain, dysphagia, pneumonia and sinusitis and others. Objective evidence of GERD is required, together with appropriate symptoms before the diagnosis can be confirmed. Before considering surgery, this objective documentation of gastroesophageal reflux is mandatory [8].

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References

  1. Fedorak RN, Veldhuyzen van Zanten S, Bridges R. Canadian Digestive Health Foundation Public Impact Series: gastroesophageal reflux disease in Canada: incidence, prevalence, and direct and indirect economic impact. Can J Gastroenterol. 2010;24:431–4.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Locke GR III, Talley NJ, Fett SL, Zinsmeister AR, Melton LJ III. Prevalence and clinical spectrum of gastroesophageal reflux: a population-based study in Olmsted County, Minnesota. Gastroenterology. 1997;112:1448–56.

    Article  PubMed  Google Scholar 

  3. Mohammed I, Cherkas LF, Riley SA, Spector TD, Trudgill NJ. Genetic influences in gastro-oesophageal reflux disease: a twin study. Gut. 2003;52:1085–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Isolauri J, Laippala P. Prevalence of symptoms suggestive of gastro-oesophageal reflux disease in an adult population. Ann Med. 1995;27:67–70.

    Article  CAS  PubMed  Google Scholar 

  5. Knox SA, Harrison CM, Britt HC, Henderson JV. Estimating prevalence of common chronic morbidities in Australia. Med J Aust. 2008;189:66–70.

    PubMed  Google Scholar 

  6. Kahrilas PJ, Shaheen NJ, Vaezi MF, et al. American Gastroenterological Association Medical Position Statement on the management of gastroesophageal reflux disease. Gastroenterology. 2008;135:1383–91. 91 e1-5.

    Article  PubMed  Google Scholar 

  7. Vakil N, van Zanten SV, Kahrilas P, Dent J, Jones R, Global Consensus G. The Montreal definition and classification of gastroesophageal reflux disease: a global evidence-based consensus. Am J Gastroenterol. 2006;101:1900–20. quiz 43.

    Article  PubMed  Google Scholar 

  8. Stefanidis D, Hope WW, Kohn GP, et al. Guidelines for surgical treatment of gastroesophageal reflux disease. Surg Endosc. 2010;24:2647–69.

    Article  PubMed  Google Scholar 

  9. Lundell LR, Dent J, Bennett JR, et al. Endoscopic assessment of oesophagitis: clinical and functional correlates and further validation of the Los Angeles classification. Gut. 1999;45:172–80.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Dent J. Endoscopic grading of reflux oesophagitis: the past, present and future. Best Pract Res Clin Gastroenterol. 2008;22:585–99.

    Article  PubMed  Google Scholar 

  11. Armstrong D, Bennett JR, Blum AL, et al. The endoscopic assessment of esophagitis: a progress report on observer agreement. Gastroenterology. 1996;111:85–92.

    Article  CAS  PubMed  Google Scholar 

  12. Lowes H, Somarathna T, Shepherd NA. Definition, derivation, and diagnosis of Barrett’s esophagus: pathological perspectives. Adv Exp Med Biol. 2016;908:111–36.

    Article  CAS  PubMed  Google Scholar 

  13. Orlando RC. Pathogenesis of reflux esophagitis and Barrett’s esophagus. Med Clin North Am. 2005;89:219–41. vii.

    Article  PubMed  Google Scholar 

  14. Bremner CG, Lynch VP, Ellis FH Jr. Barrett’s esophagus: congenital or acquired? An experimental study of esophageal mucosal regeneration in the dog. Surgery. 1970;68:209–16.

    CAS  PubMed  Google Scholar 

  15. Chen MY, Ott DJ, Sinclair JW, Wu WC, Gelfand DW. Gastroesophageal reflux disease: correlation of esophageal pH testing and radiographic findings. Radiology. 1992;185:483–6.

    Article  CAS  PubMed  Google Scholar 

  16. Thompson JK, Koehler RE, Richter JE. Detection of gastroesophageal reflux: value of barium studies compared with 24-hr pH monitoring. AJR Am J Roentgenol. 1994;162:621–6.

    Article  CAS  PubMed  Google Scholar 

  17. Bombeck CT, Helfrich GB, Nyhus LM. Planning surgery for reflux esophagitis and hiatus hernia. Surg Clin North Am. 1970;50:29–44.

    Article  CAS  PubMed  Google Scholar 

  18. Mattox HE III, Richter JE. Prolonged ambulatory esophageal pH monitoring in the evaluation of gastroesophageal reflux disease. Am J Med. 1990;89:345–56.

    Article  PubMed  Google Scholar 

  19. Pope CE II. Pathophysiology and diagnosis of reflux esophagitis. Gastroenterology. 1976;70:445–54.

    PubMed  Google Scholar 

  20. Wiener GJ, Morgan TM, Copper JB, et al. Ambulatory 24-hour esophageal pH monitoring. Reproducibility and variability of pH parameters. Dig Dis Sci. 1988;33:1127–33.

    Article  CAS  PubMed  Google Scholar 

  21. Kohn GP. pH and impedance evaluation of the esophagus. In: Yeo CJ, editor. Shackelford’s surgery of the alimentary tract. 8th ed. Philadelphia, PA: Elsevier; in press.

    Google Scholar 

  22. Hirano I, Richter JE, Practice Parameters Committee of the American College of G. ACG practice guidelines: esophageal reflux testing. Am J Gastroenterol. 2007;102:668–85.

    Article  PubMed  Google Scholar 

  23. Ter RB, Johnston BT, Castell DO. Exclusion of the meal period improves the clinical reliability of esophageal pH monitoring. J Clin Gastroenterol. 1997;25:314–6.

    Article  CAS  PubMed  Google Scholar 

  24. Arora AS, Murray JA. Streamlining 24-hour pH study for GERD: use of a 3-hour postprandial test. Dig Dis Sci. 2003;48:10–5.

    Article  PubMed  Google Scholar 

  25. Wong WM, Bautista J, Dekel R, et al. Feasibility and tolerability of transnasal/per-oral placement of the wireless pH capsule vs. traditional 24-h oesophageal pH monitoring--a randomized trial. Aliment Pharmacol Ther. 2005;21:155–63.

    Article  PubMed  Google Scholar 

  26. Pandolfino JE, Richter JE, Ours T, Guardino JM, Chapman J, Kahrilas PJ. Ambulatory esophageal pH monitoring using a wireless system. Am J Gastroenterol. 2003;98:740–9.

    Article  PubMed  Google Scholar 

  27. Wenner J, Johnsson F, Johansson J, Oberg S. Wireless esophageal pH monitoring is better tolerated than the catheter-based technique: results from a randomized cross-over trial. Am J Gastroenterol. 2007;102:239–45.

    Article  CAS  PubMed  Google Scholar 

  28. Prakash C, Clouse RE. Value of extended recording time with wireless pH monitoring in evaluating gastroesophageal reflux disease. Clin Gastroenterol Hepatol. 2005;3:329–34.

    Article  PubMed  Google Scholar 

  29. Ahlawat SK, Novak DJ, Williams DC, Maher KA, Barton F, Benjamin SB. Day-to-day variability in acid reflux patterns using the BRAVO pH monitoring system. J Clin Gastroenterol. 2006;40:20–4.

    Article  PubMed  Google Scholar 

  30. Bhat YM, McGrath KM, Bielefeldt K. Wireless esophageal pH monitoring: new technique means new questions. J Clin Gastroenterol. 2006;40:116–21.

    Article  PubMed  Google Scholar 

  31. Hirano I, Zhang Q, Pandolfino JE, Kahrilas PJ. Four-day Bravo pH capsule monitoring with and without proton pump inhibitor therapy. Clin Gastroenterol Hepatol. 2005;3:1083–8.

    Article  PubMed  Google Scholar 

  32. Anggiansah A, Sumboonnanonda K, Wang J, Linsell J, Hale P, Owen WJ. Significantly reduced acid detection at 10 centimeters compared to 5 centimeters above lower esophageal sphincter in patients with acid reflux. Am J Gastroenterol. 1993;88:842–6.

    CAS  PubMed  Google Scholar 

  33. Wenner J, Johnsson F, Johansson J, Oberg S. Acid reflux immediately above the squamocolumnar junction and in the distal esophagus: simultaneous pH monitoring using the wireless capsule pH system. Am J Gastroenterol. 2006;101:1734–41.

    Article  PubMed  Google Scholar 

  34. Lee YY, Whiting JG, Robertson EV, et al. Kinetics of transient hiatus hernia during transient lower esophageal sphincter relaxations and swallows in healthy subjects. Neurogastroenterol Motil. 2012;24:990–e539.

    Article  CAS  PubMed  Google Scholar 

  35. Edmundowicz SA, Clouse RE. Shortening of the esophagus in response to swallowing. Am J Physiol. 1991;260:G512–6.

    CAS  PubMed  Google Scholar 

  36. Kahrilas PJ, Quigley EM. Clinical esophageal pH recording: a technical review for practice guideline development. Gastroenterology 1996;110:1982–96.

    Google Scholar 

  37. Mattox HE III, Richter JE, Sinclair JW, Price JE, Case LD. Gastroesophageal pH step-up inaccurately locates proximal border of lower esophageal sphincter. Dig Dis Sci. 1992;37:1185–91.

    Article  PubMed  Google Scholar 

  38. Kahrilas PJ, Lin S, Chen J, Manka M. The effect of hiatus hernia on gastro-oesophageal junction pressure. Gut. 1999;44:476–82.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  39. Ayazi S, Lipham JC, Portale G, et al. Bravo catheter-free pH monitoring: normal values, concordance, optimal diagnostic thresholds, and accuracy. Clin Gastroenterol Hepatol. 2009;7:60–7.

    Article  PubMed  Google Scholar 

  40. Tuttle SG, Rufin F, Bettarello A. The physiology of heartburn. Ann Intern Med. 1961;55:292–300.

    Article  CAS  PubMed  Google Scholar 

  41. Ouatu-Lascar R, Lin OS, Fitzgerald RC, Triadafilopoulos G. Upright versus supine reflux in gastroesophageal reflux disease. J Gastroenterol Hepatol. 2001;16:1184–90.

    Article  CAS  PubMed  Google Scholar 

  42. Campos GM, Peters JH, DeMeester TR, Oberg S, Crookes PF, Mason RJ. The pattern of esophageal acid exposure in gastroesophageal reflux disease influences the severity of the disease. Arch Surg. 1999;134:882–7. discussion 7–8.

    Article  CAS  PubMed  Google Scholar 

  43. Saraswat VA, Dhiman RK, Mishra A, Naik SR. Correlation of 24-hr esophageal pH patterns with clinical features and endoscopy in gastroesophageal reflux disease. Dig Dis Sci. 1994;39:199–205.

    Article  CAS  PubMed  Google Scholar 

  44. Johnson LF, Demeester TR. Twenty-four-hour pH monitoring of the distal esophagus. A quantitative measure of gastroesophageal reflux. Am J Gastroenterol. 1974;62:325–32.

    CAS  PubMed  Google Scholar 

  45. Bredenoord AJ, Weusten BL, Smout AJ. Symptom association analysis in ambulatory gastro-oesophageal reflux monitoring. Gut. 2005;54:1810–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  46. Öberg S. Esophageal pH monitoring. In: Yeo CJ, editor. Shackelford’s surgery of the alimentary tract. 7th ed. Philadelphia, PA: Saunders; 2013. p. 147–53.

    Google Scholar 

  47. Tutuian R, Castell DO. Gastroesophageal reflux monitoring: pH and impedance. GI Motility Online. 2006.

    Google Scholar 

  48. Weusten BL, Roelofs JM, Akkermans LM, Van Berge-Henegouwen GP, Smout AJ. The symptom-association probability: an improved method for symptom analysis of 24-hour esophageal pH data. Gastroenterology. 1994;107:1741–5.

    Article  CAS  PubMed  Google Scholar 

  49. Fackler WK, Ours TM, Vaezi MF, Richter JE. Long-term effect of H2RA therapy on nocturnal gastric acid breakthrough. Gastroenterology. 2002;122:625–32.

    Article  CAS  PubMed  Google Scholar 

  50. Bell NJ, Burget D, Howden CW, Wilkinson J, Hunt RH. Appropriate acid suppression for the management of gastro-oesophageal reflux disease. Digestion. 1992;51(Suppl 1):59–67.

    Article  PubMed  Google Scholar 

  51. Johnsson F, Joelsson B, Isberg PE. Ambulatory 24 hour intraesophageal pH-monitoring in the diagnosis of gastroesophageal reflux disease. Gut. 1987;28:1145–50.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  52. Jamieson JR, Stein HJ, DeMeester TR, et al. Ambulatory 24-h esophageal pH monitoring: normal values, optimal thresholds, specificity, sensitivity, and reproducibility. Am J Gastroenterol. 1992;87:1102–11.

    CAS  PubMed  Google Scholar 

  53. Wenner J, Johansson J, Johnsson F, Oberg S. Optimal thresholds and discriminatory power of 48-h wireless esophageal pH monitoring in the diagnosisof GERD. Am J Gastroenterol. 2007;102:1862–9.

    Article  PubMed  Google Scholar 

  54. Venables TL, Newland RD, Patel AC, Hole J, Wilcock C, Turbitt ML. Omeprazole 10 milligrams once daily, omeprazole 20 milligrams once daily, or ranitidine 150 milligrams twice daily, evaluated as initial therapy for the relief of symptoms of gastro-oesophageal reflux disease in general practice. Scand J Gastroenterol. 1997;32:965–73.

    Article  CAS  PubMed  Google Scholar 

  55. Cherry J, Margulies SI. Contact ulcer of the larynx. Laryngoscope. 1968;78:1937–40.

    Article  CAS  PubMed  Google Scholar 

  56. Mahieu HF. Review article: the laryngological manifestations of reflux disease; why the scepticism? Aliment Pharmacol Ther. 2007;26(Suppl 2):17–24.

    Article  PubMed  Google Scholar 

  57. Ayazi S, Hagen JA, Zehetner J, et al. Proximal esophageal pH monitoring: improved definition of normal values and determination of a composite pH score. J Am Coll Surg. 2010;210:345–50.

    Article  PubMed  Google Scholar 

  58. Chen RY, Thomas RJ. Results of laparoscopic fundoplication where atypical symptoms coexist with oesophageal reflux. Aust N Z J Surg. 2000;70:840–2.

    Article  CAS  PubMed  Google Scholar 

  59. Swoger J, Ponsky J, Hicks DM, et al. Surgical fundoplication in laryngopharyngeal reflux unresponsive to aggressive acid suppression: a controlled study. Clin Gastroenterol Hepatol. 2006;4:433–41.

    Article  PubMed  Google Scholar 

  60. Ummarino D, Vandermeulen L, Roosens B, Urbain D, Hauser B, Vandenplas Y. Gastroesophageal reflux evaluation in patients affected by chronic cough: restech versus multichannel intraluminal impedance/pH metry. Laryngoscope. 2013;123:980–4.

    Article  PubMed  Google Scholar 

  61. Patel DA, Harb AH, Vaezi MF. Oropharyngeal reflux monitoring and atypical gastroesophageal reflux disease. Curr Gastroenterol Rep. 2016;18:12.

    Article  PubMed  Google Scholar 

  62. Tutuian R, Castell DO. Multichannel intraluminal impedance. In: Yeo CJ, editor. Shackelford’s surgery of the alimentary tract. 7th ed. Philadelphia, PA: Saunders; 2013. p. 154–61.

    Google Scholar 

  63. Mainie I, Tutuian R, Agrawal A, Adams D, Castell DO. Combined multichannel intraluminal impedance-pH monitoring to select patients with persistent gastro-oesophageal reflux for laparoscopic Nissen fundoplication. Br J Surg. 2006;93:1483–7.

    Article  CAS  PubMed  Google Scholar 

  64. Sifrim D, Castell D, Dent J, Kahrilas PJ. Gastro-oesophageal reflux monitoring: review and consensus report on detection and definitions of acid, non-acid, and gas reflux. Gut. 2004;53:1024–31.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  65. Shay S, Tutuian R, Sifrim D, et al. Twenty-four hour ambulatory simultaneous impedance and pH monitoring: a multicenter report of normal values from 60 healthy volunteers. Am J Gastroenterol. 2004;99:1037–43.

    Article  PubMed  Google Scholar 

  66. Ndebia EJ, Sammon AM, Umapathy E, Iputo JE. Normal values of 24-hour ambulatory esophageal impedance-pH monitoring in a rural South African cohort of healthy participants. Dis Esophagus. 2016;29:385.

    Article  CAS  PubMed  Google Scholar 

  67. Xiao YL, Lin JK, Cheung TK, et al. Normal values of 24-hour combined esophageal multichannel intraluminal impedance and pH monitoring in the Chinese population. Digestion. 2009;79:109–14.

    Article  PubMed  Google Scholar 

  68. Zerbib F, des Varannes SB, Roman S, et al. Normal values and day-to-day variability of 24-h ambulatory oesophageal impedance-pH monitoring in a Belgian-French cohort of healthy subjects. Aliment Pharmacol Ther. 2005;22:1011–21.

    Article  CAS  PubMed  Google Scholar 

  69. Ribolsi M, Savarino E, De Bortoli N, et al. Reflux pattern and role of impedance-pH variables in predicting PPI response in patients with suspected GERD-related chronic cough. Aliment Pharmacol Ther. 2014;40:966–73.

    Article  CAS  PubMed  Google Scholar 

  70. del Genio G, Tolone S, del Genio F, et al. Prospective assessment of patient selection for antireflux surgery by combined multichannel intraluminal impedance pH monitoring. J Gastrointest Surg. 2008;12:1491–6.

    Article  PubMed  Google Scholar 

  71. Malhotra A, Freston JW, Aziz K. Use of pH-impedance testing to evaluate patients with suspected extraesophageal manifestations of gastroesophageal reflux disease. J Clin Gastroenterol. 2008;42:271–8.

    PubMed  Google Scholar 

  72. Bajbouj M, Becker V, Neuber M, Schmid RM, Meining A. Combined pH-metry/impedance monitoring increases the diagnostic yield in patients with atypical gastroesophageal reflux symptoms. Digestion. 2007;76:223–8.

    Article  PubMed  Google Scholar 

  73. Forootan M, Ardeshiri M, Etemadi N, Maghsoodi N, Poorsaadati S. Findings of impedance pH-monitoring in patients with atypical gastroesophageal reflux symptoms. Gastroenterol Hepatol Bed Bench. 2013;6:S117–21.

    PubMed  PubMed Central  Google Scholar 

  74. Chakravorty P, Bashah KF, Kohn GP. PS01.054 Correlation between pH studies and esophageal impedance in the evaluation of typical GERD symptoms (poster). 15th International Society for Diseases of the Esophagus World Congress. 2016.

    Google Scholar 

  75. Attwood SE, Lundell L, Hatlebakk JG, et al. Medical or surgical management of GERD patients with Barrett’s esophagus: the LOTUS trial 3-year experience. J Gastrointest Surg. 2008;12:1646–54. discussion 54–5.

    Article  CAS  PubMed  Google Scholar 

  76. Pessaux P, Arnaud JP, Delattre JF, Meyer C, Baulieux J, Mosnier H. Laparoscopic antireflux surgery: five-year results and beyond in 1340 patients. Arch Surg. 2005;140:946–51.

    Article  PubMed  Google Scholar 

  77. O’Boyle CJ, Watson DI, Jamieson GG, Myers JC, Game PA, Devitt PG. Division of short gastric vessels at laparoscopic nissen fundoplication: a prospective double-blind randomized trial with 5-year follow-up. Ann Surg. 2002;235:165–70.

    Article  PubMed  PubMed Central  Google Scholar 

  78. Triponez F, Dumonceau JM, Azagury D, et al. Reflux, dysphagia, and gas bloat after laparoscopic fundoplication in patients with incidentally discovered hiatal hernia and in a control group. Surgery. 2005;137:235–42.

    Article  PubMed  Google Scholar 

  79. Brehant O, Pessaux P, Arnaud JP, et al. Long-term outcome of laparoscopic antireflux surgery in the elderly. J Gastrointest Surg. 2006;10:439–44.

    Article  PubMed  Google Scholar 

  80. Anvari M, Allen C. Five-year comprehensive outcomes evaluation in 181 patients after laparoscopic Nissen fundoplication. J Am Coll Surg. 2003;196:51–7. discussion 7–8; author reply 8–9.

    Article  PubMed  Google Scholar 

  81. Wayman J, Myers JC, Jamieson GG. Preoperative gastric emptying and patterns of reflux as predictors of outcome after laparoscopic fundoplication. Br J Surg. 2007;94:592–8.

    Article  CAS  PubMed  Google Scholar 

  82. Kohn GP, Price RR, Demeester SR, et al. Guidelines for the management of hiatal hernia. Surg Endosc. 2013;27:4409–28.

    Article  PubMed  Google Scholar 

  83. Scheffer RC, Bredenoord AJ, Hebbard GS, Smout AJ, Samsom M. Effect of proximal gastric volume on hiatal hernia. Neurogastroenterol Motil. 2010;22:552–6. e120.

    CAS  PubMed  Google Scholar 

  84. Fornari F, Madalosso CA, Farre R, Gurski RR, Thiesen V, Callegari-Jacques SM. The role of gastro-oesophageal pressure gradient and sliding hiatal hernia on pathological gastro-oesophageal reflux in severely obese patients. Eur J Gastroenterol Hepatol. 2010;22:404–11.

    Article  PubMed  Google Scholar 

  85. Franzen T, Tibbling L. Is the severity of gastroesophageal reflux dependent on hiatus hernia size? World J Gastroenterol. 2014;20:1582–4.

    Article  PubMed  PubMed Central  Google Scholar 

  86. Ott DJ, Glauser SJ, Ledbetter MS, Chen MY, Koufman JA, Gelfand DW. Association of hiatal hernia and gastroesophageal reflux: correlation between presence and size of hiatal hernia and 24-hour pH monitoring of the esophagus. AJR Am J Roentgenol. 1995;165:557–9.

    Article  CAS  PubMed  Google Scholar 

  87. Mittal SK, Awad ZT, Tasset M, et al. The preoperative predictability of the short esophagus in patients with stricture or paraesophageal hernia. Surg Endosc. 2000;14:464–8.

    Article  CAS  PubMed  Google Scholar 

  88. Morcos SK. Review article: effects of radiographic contrast media on the lung. Br J Radiol. 2003;76:290–5.

    Article  CAS  PubMed  Google Scholar 

  89. Kahrilas PJ, Kim HC, Pandolfino JE. Approaches to the diagnosis and grading of hiatal hernia. Best Pract Res Clin Gastroenterol. 2008;22:601–16.

    Article  PubMed  PubMed Central  Google Scholar 

  90. Swanstrom LL, Jobe BA, Kinzie LR, Horvath KD. Esophageal motility and outcomes following laparoscopic paraesophageal hernia repair and fundoplication. Am J Surg. 1999;177:359–63.

    Article  CAS  PubMed  Google Scholar 

  91. Boushey RP, Moloo H, Burpee S, et al. Laparoscopic repair of paraesophageal hernias: a Canadian experience. Can J Surg. 2008;51:355–60.

    PubMed  PubMed Central  Google Scholar 

  92. Nagpal AP, Soni H, Haribhakti S. Is oesophageal manometry a must before laparoscopic fundoplication? Analysis of 46 consecutive patients treated without preoperative manometry. J Minim Access Surg. 2010;6:66–9.

    Article  PubMed  PubMed Central  Google Scholar 

  93. Roman S, Kahrilas PJ, Kia L, Luger D, Soper N, Pandolfino JE. Effects of large hiatal hernias on esophageal peristalsis. Arch Surg. 2012;147:352–7.

    Article  PubMed  PubMed Central  Google Scholar 

  94. Ye P, Li ZS, Xu GM, Zou DW, Xu XR, Lu RH. Esophageal motility in patients with sliding hiatal hernia with reflux esophagitis. Chin Med J (Engl). 2008;121:898–903.

    Google Scholar 

  95. Shih WJ, Milan PP. Gastric-emptying scintigraphy of type III hiatal hernia: a case report. J Nucl Med Technol. 2005;33:83–5.

    PubMed  Google Scholar 

  96. Khouzam RN, Akhtar A, Minderman D, Kaiser J, D’Cruz IA. Echocardiographic aspects of hiatal hernia: a review. J Clin Ultrasound. 2007;35:196–203.

    Article  PubMed  Google Scholar 

  97. Naoum C, Falk GL, Ng AC, et al. Left atrial compression and the mechanism of exercise impairment in patients with a large hiatal hernia. J Am Coll Cardiol. 2011;58:1624–34.

    Article  PubMed  Google Scholar 

  98. Fornari F, Gurski RR, Navarini D, Thiesen V, Mestriner LH, Madalosso CA. Clinical utility of endoscopy and barium swallow X-ray in the diagnosis of sliding hiatal hernia in morbidly obese patients: a study before and after gastric bypass. Obes Surg. 2010;20:702–8.

    Article  PubMed  Google Scholar 

  99. Gourgiotis S, Vougas V, Germanos S, Baratsis S. Acute gastric volvulus: diagnosis and management over 10 years. Dig Surg. 2006;23:169–72.

    Article  PubMed  Google Scholar 

  100. Shafii AE, Agle SC, Zervos EE. Perforated gastric corpus in a strangulated paraesophageal hernia: a case report. J Med Case Reports. 2009;3:6507.

    Article  PubMed Central  Google Scholar 

  101. Chang CC, Tseng CL, Chang YC. A surgical emergency due to an incarcerated paraesophageal hernia. Am J Emerg Med. 2009;27:134.e1–3.

    Google Scholar 

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Correspondence to Geoffrey P. Kohn MBBS(Hons), MSurg, FRACS, FACS .

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Kohn, G.P. (2018). Preoperative Diagnostic Workup for GERD and Hiatal Hernia: An Evidence and Experience-Based Approach. In: Memon, M. (eds) Hiatal Hernia Surgery. Springer, Cham. https://doi.org/10.1007/978-3-319-64003-7_4

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