[Impaired lung function and anemia from large hiatal hernia: a case report]. / Alterazioni della funzione respiratoria ed anemia da voluminosa ernia iatale: descrizione di un caso.

We present the clinical case of a 54 years old man who accessed for dyspnea and severe anemia. After being transfused, he underwent to gastroscopy, which showed an erosive gastritis with large hiatal hernia. The hernia was surgically reduced with laparoscopic hiatoplastic and Nissen-Rossetti fundoplication. In conclusion, dyspnea is not merely a medical competence but also a surgical one.

[Anemia as the only symptom of esophageal hiatal hernia of the diaphragm].

The clinical case of chronic post-hemorrhagic iron deficiency anemia in patients with large hiatal hernia is represented in this article.

Study of arteriosclerosis in patients with hiatal hernia and reflux esophagitis.

BACKGROUND AND AIM: It has been reported that the prevalence of hiatal hernia (HH) and reflux esophagitis (RE) increases with age, as does the degree of arteriosclerosis. However, it has not been investigated whether or not arteriosclerosis is correlated with the presence of HH and RE. Therefore, we prospectively investigated the degree of arteriosclerosis in patients with HH and RE compared with subjects without HH and RE. METHODS: We prospectively enrolled 1683 people who visited Shimane Environment and Health Public Corporation for annual medical check-ups. All subjects were investigated by upper gastrointestinal endoscopy for the possible presence of HH and RE. Factors used for assessing cardiovascular risk were sex, age, body mass index (BMI), smoking and drinking habits, serum total cholesterol, triglyceride (TG), and high-density lipoprotein cholesterol (HDLC). Arteriosclerosis was investigated by measuring systolic blood pressure, heart-carotid pulse wave velocity (HCPWV), bilateral ankle brachial index (ABI) and heart-ankle PWV (HAPWV). RESULTS: The number of patients with HH and RE was 624 (37.1%) and 143 (8.5%), respectively. The HDLC level of the patients with HH was significantly lower, and the levels of BMI, TG and arteriosclerotic parameters were higher than those of the subjects without HH after adjusting for confounding factors (sex, age and smoking and drinking habits). Cardiovascular and arteriosclerosis parameters except for TG did not differ between the subjects with and without RE. CONCLUSION: Levels of arteriosclerosis parameters in patients with HH were higher than in those without HH. However, the association between arteriosclerosis and presence of RE was not clarified.

Effects of percutaneous endoscopic gastrostomy tube placement on gastric antral motility and gastric emptying.

BACKGROUND: Percutaneous endoscopic gastrostomy (PEG) is the preferred method for providing enteral nutritional support in patients with dysphagia. We examined gastric antral myoelectrical activity and gastric emptying before and after PEG tube placement to evaluate the effects of PEG on gastric motility. METHODS: PEG was performed in 41 patients; 21 fed by total parenteral nutrition (TPN) and 20 who received nasogastric tube feeding (NGF). Antral myoelectrical activity and gastric emptying were examined before and 4 weeks after PEG tube placement. RESULTS: The percentage of normal-range electrogastrograms (EGGs) was significantly lower in the TPN group than in the NGF group in both the pre- and postprandial periods before PEG tube placement. Enteral feeding after PEG tube placement improved gastric motility in the patients with TPN. The percentage of normal-range EGGs increased significantly after PEG tube placement in both the pre- and postprandial periods, and plasma concentrations of paracetamol increased significantly after PEG tube placement in patients with TPN. A total of 7.3% of the patients developed the complication of gastroesophageal reflux (GER) after PEG tube placement. Gastric myoelectrical activity and gastric emptying were improved in these patients with GER after PEG tube placement. In contrast, the prevalence of esophageal hiatus hernia was significantly higher in patients with GER after PEG tube placement than in patients without GER after PEG tube placement. CONCLUSIONS: Prolonged TPN with bowel rest induces physiological dysfunction of gastric motility. Enteral nutrition is the preferable physiological nutritional route. GER after PEG tube placement is not related to gastric motility. Esophageal hiatus hernia seems to be a major risk factor for GER complications after PEG tube placement. Percutaneous endoscopic gastrostomy (PEG) is the preferred method for providing enteral nutritional support in patients with dysphagia. We examined gastric antral myoelectrical activity and gastric emptying before and after PEG tube placement to evaluate the effects of PEG on gastric motility.

Preoperative and postoperative levels of plasma protein and amino acid in esophageal and lung cancer patients.

The metabolic changes following thoracic surgery in three groups of patients (esophageal cancer, lung cancer, and hiatus hernia) have been studied. Before operation patients with esophageal cancer, but not those with lung cancer, had significantly lower plasma total protein and albumin than patients with hiatus hernia. After surgery plasma albumin and total protein fell in both esophageal cancer and hiatus hernia patients, a development attributed to poor nutrition and restricted calorie diet in these two groups of patients respectively. With the exception of alanine and arginine in lung cancer patients, and free tryptophan in lung and esophageal cancer patients, the preoperative concentrations of all plasma amino acids were similar in both groups of cancer patients and in those with hiatus hernia. After operation the concentrations of glutamine, total tryptophan, alanine, glycine, and arginine fell sharply, whereas those of phenylalanine, lysine, valine, and leucine were slightly or not at all affected by surgery. The immediate postoperative fall of plasma free amino acids is thought to be due to the increased rate of gluconeogenesis. The rise of free fraction of plasma tryptophan after surgery is related to the raised level of plasma free fatty acids and increased secretions of catecholamines, which is believed to follow surgery.

[Serum gastrin in various diseases of the digestive system. Clinical experience]. / Gastrinemia in alcune affezioni dell'apparato digerente Esperienza clinica

Fasting and after meals serum gastrin levels were determined in healthy subjects and patients with different gastroenterological diseases (duodenal and gastric ulcer, hiatal hernia with gastroesophageal reflux, Billroth II gastric resection, atrophic gastritis, Zollinger-Ellison, Ménétrier, chronic calcifying pancreatitis, gastric carcinoma and lymphoma). The results pointed to the usefulness of evaluating both fasting levels and "gastrin curve" after meals as an expression of the rapidity of response of hormone-secreting gastric cells. Calculation of the I.G.O. (Integrated Gastrin Output) must also be carried out to provide a parameter from which the overall ability of G cells to secrete in response to feeding can be assessed.

The role of gastrin in the treatment of sliding hiatal hernia with reflux using the reefing method of fundoplication.

Findings in this study correlated a low circulating gastrin level with an incompetent lower esophageal sphincter mechanism and abnormal reflux. Such reflux, in amounts causing esophagitis distally, was treated surgically by a mechanically simple method of fundoplication. The success of this reefing method of fundoplication was explained by using physiologically active sling fibers of the gastric fundus to augment the lower esophageal sphincter. Available gastrin was used more effectively in this manner. The high incidence of associated foregut diseases suggested an embryologic factor in the development of gastroesophageal reflux. The dilated hiatus and its attendant hernia had no apparent relationship to the development of reflux esophagitis. The term symptomatic sliding hiatal hernia, therefore, seemed to be a diagnostic and therapeutic misnomer.

Serum gastrin level in early childhood.

Serum gastrin concentration was measured in newborns and infants with no gastrointestinal disorders, in the fasting state and after food stimulation. Mean fasting concentration in 14 newborns aged 1 to 12 days (130 . 4 pg/ml +/- 11 . 4 SE) was significantly higher than the mean value in 23 infants aged 1.5 to 22 months (101.4 +/- 6.6 pg/ml). Ingestion of the usual milk meal resulted in a definite rise of the serum gastrin level in the 5 subjects tested (3 newborns and 2 infants). The mean fasting serum gastrin level in 6 babies with hiatus hernia and gastro-oesophageal reflux was found to be no different from the corresponding value in 8 age-matched controls. However, a conspicuously raised fasting gastrin concentration was observed in one infant with lower oesophageal dyskinesia. The results indicate that the release of gastrin and the reactivity of the hormone-producing sites to food stimulation in early life are similar to those in adult humans. No defect of gastrin release was shown in patients with gastro-oesophageal reflux.

Correlation of lower esophageal sphincter pressure and serum gastrin level in man.

Resting lower esophageal sphincter pressures and fasting serum gastrin levels were measured in 35 consecutive patients. 28 of these patients were subdivided into Group I, which consisted of 9 patients with symptomatic gastroesophageal reflux and hiatus hernia, and Group II was further subdivided into Group IIA, 5 patients with hiatus hernias, and Group IIB, 14 patients without hiatus hernia. Mean LES pressures for Groups I, IIA, and IIB were 9.7, 36.8, and 25.6 cm H2O, and serum gastrin levels were 129, 74, and 116 pg/ml, respectively. Examination of these data as a whole or as subgroups failed to demonstrate a correlation between these two variables. The remaining 7 patients had abnormal sphincters (3 patients which scleroderma and 2 with achalasia) or abnormal serum gastrin levels (1 patient with pernicious anemia and 1 patient with antrectomy and Billroth II anastomosis). For these patients as well, no correlation between LES pressure and serum gastrin level was found. These results cast doubt on the hypothesis that endogenous gastrin is a major factor in the maintenance of resting LES pressure.