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Baker FA, Savarino E, Ahmad HS, Zeina AR, Abboud W, Khoury T, Natour RT, Kopelman Y, Mari A. Comprehensive Assessment of Esophageal Disorders Associated with Hiatus Hernia: Insights from Big Data Analysis. Dysphagia 2024:10.1007/s00455-023-10642-6. [PMID: 38285232 DOI: 10.1007/s00455-023-10642-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Accepted: 11/06/2023] [Indexed: 01/30/2024]
Abstract
Hiatus hernia (HH) is a prevalent endoscopic finding in clinical practice, frequently co-occurring with esophageal disorders, yet the prevalence and degree of association remain uncertain. We aim to investigate HH's frequency and its suspected association with esophageal disorders. We reviewed endoscopic reports of over 75,000 consecutive patients who underwent gastroscopy over 12 years in two referral centers. HH was endoscopically diagnosed. We derived data on clinical presentation and a comprehensive assessment of benign and malignant esophageal pathologies. We performed multiple regression models to identify esophageal sequela associated with HH. The overall frequency of HH was (16.8%); the majority (89.5%) had small HHs (<3 cm). Female predominance was documented in HH patients, who were significantly older than controls (61.1±16.5 vs. 52.7±20.0; P < 0.001). The outcome analysis of esophageal pathology revealed an independent association between HH, regardless of its size, and erosive reflux esophagitis (25.7% vs. 6.2%; OR = 3.8; P < 0.001) and Barrett's esophagus (3.8% vs. 0.7%; OR = 4.7, P < 0.001). Furthermore, following rigorous age and sex matching, in conjunction with additional multivariable analyses, large HHs were associated with higher rates of benign esophageal strictures (3.6% vs. 0.3%; P < 0.001), Mallory Weiss syndrome (3.6% vs. 2.1%; P = 0.01), and incidents of food impactions (0.9% vs. 0.2%; P = 0.014). In contrast, a lower rate of achalasia was noted among this cohort (0.55% vs. 0%; P = 0.046). Besides reflux-related esophageal disorders, we outlined an association with multiple benign esophageal disorders, particularly in patients with large HHs.
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Affiliation(s)
- Fadi Abu Baker
- Department of Gastroenterology and Hepatology, Hillel Yaffe Medical Center, Hadera, Israel
| | - Edoardo Savarino
- Division of Gastroenterology, Department of Surgical, Oncological and Gastroenterological Sciences, University of Padua, Padua, Italy
| | - Helal Said Ahmad
- Department of Gastroenterology, Azrieli Faculty of Medicine, Nazareth EMMS Hospital, Bar Ilan University, Safed, Israel
| | - Abdel-Rauf Zeina
- Department of Radiology, Hillel Yaffe Medical Center, Hadera, Israel
| | - Wisam Abboud
- Department of Surgery, Nazareth Hospital, EMMS, Nazareth, Faculty of Medicine, Bar-Ilan University, Ramat Gan, Israel
| | - Tawfik Khoury
- Department of Gastroenterology, Faculty of Medicine in the Galilee, Galilee Medical Center, Bar-Ilan University, Nahariya, Safed, Israel
| | - Randa Taher Natour
- Department of Gastroenterology and Hepatology, Hillel Yaffe Medical Center, Hadera, Israel.
- Department of Internal Medicine, Hillel Yaffe Medical Center, Hadera, Israel.
| | - Yael Kopelman
- Department of Gastroenterology and Hepatology, Hillel Yaffe Medical Center, Hadera, Israel
| | - Amir Mari
- Department of Gastroenterology, Azrieli Faculty of Medicine, Nazareth EMMS Hospital, Bar Ilan University, Safed, Israel
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Ling W, Huang Y, Xu JH, Li Y, Huang YM, Ling HB, Sui Y, Zhao HL. Consistent Efficacy of Wendan Decoction for the Treatment of Digestive Reflux Disorders. Am J Chin Med 2015; 43:893-913. [PMID: 26243580 DOI: 10.1142/s0192415x15500524] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Gastroesophageal reflux disease (GERD) and bile reflux gastritis (BRG) are common gastrointestinal (GI) disorders with unmet medical needs. Traditional Chinese medicine has long been used for the treatment of GERD and BRG whereas the ginger-containing formula Wendan decoction (WDD) targets homeostatic disturbances characterized by "reflux" and "gut-juice exposure" problems. Here we used WDD as a therapeutic tool to unravel the common pathogenesis of GI reflux disorders. Control clinical trials reporting the WDD-treated patients with GERD and BRG were included in this systematic review and meta-analysis. Outcome measurements were clinical efficacy defined by symptom relief with normal GI endoscopy, radiology, and pathology. Eventually, 33 studies involved 3253 participants (1351 vs. 1035 of the BRG in 20 publications, 449 vs. 418 of the GERD in 13 studies, and 194 vs. 159 of relapse rate in 6 trials). Pooled data showed a consistent therapeutic efficacy of WDD on BRG (OR = 6.00, 95%C = 4.68-7.69) and GERD (OR = 4.39, 95%CI = 2.72-7.07). The relapse rate was 12.4% for WDD, significantly lower than 44.0% for conventional therapies (OR = 0.14, 95%CI = 0.08-0.26). The consistent therapeutic efficacy of the single TCM formula on GERD and BRD indirectly indicates reflux as a common pathogenesis in reflux-associated GI disorders.
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Affiliation(s)
- Wei Ling
- Center for Systems Medicine, Guangxi Key Laboratory of Excellence, Guilin Medical University, Guilin 541004, China
| | - Yi Huang
- Center for Systems Medicine, Guangxi Key Laboratory of Excellence, Guilin Medical University, Guilin 541004, China.,Department of Traditional Chinese Medicine, Guigang Hospital of Traditional Chinese Medicine, Guigang 537100, Guangxi, China
| | - Jia-Hua Xu
- Center for Systems Medicine, Guangxi Key Laboratory of Excellence, Guilin Medical University, Guilin 541004, China.,Department of Traditional Chinese Medicine, Fangchenggang Hospital of Traditional Chinese Medicine, Fangchenggang 538021, Guangxi, China
| | - Yang Li
- Center for Systems Medicine, Guangxi Key Laboratory of Excellence, Guilin Medical University, Guilin 541004, China.,Department of Gastroenterology, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot 010050, China
| | - Yan-Mei Huang
- Center for Systems Medicine, Guangxi Key Laboratory of Excellence, Guilin Medical University, Guilin 541004, China
| | - Hai-Bing Ling
- Center for Systems Medicine, Guangxi Key Laboratory of Excellence, Guilin Medical University, Guilin 541004, China.,Department of Orthopedics, People Hospital of Rong County, Rong Xian 637500, Guangxi, China
| | - Yi Sui
- Guangdong Hospital of Traditional Chinese Medicine, Guangzhou University of Chinese Medicine, Guangzhou 510120, China
| | - Hai-Lu Zhao
- Center for Systems Medicine, Guangxi Key Laboratory of Excellence, Guilin Medical University, Guilin 541004, China
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