P0293 - Intermittent Hiatus Hernia on High Resolution Manometry Associates With Reflux Metrics Similar to Persistent Hiatus Hernia

Surosree Ganguli, MD¹, Samantha Zarro, MD², Janki Luther, MD, MPH³, C. Prakash Gyawali, MD, MRCP, FACG³, Farid Kehdy, MD¹, Benjamin Rogers, MD^1
1University of Louisville, Louisville, KY; ²Barnes-Jewish Hospital at Washington University in St. Louis, St. Louis, MO; ³Washington University in St. Louis, St. Louis, MO

Introduction: Presence of a hiatus hernia (HH) on high resolution manometry (HRM) is associated with elevated reflux burden on ambulatory reflux monitoring. However, HH can be sliding and intermittent in nature, where implications on reflux burden have not been systematically evaluated. We compared reflux metrics on ambulatory reflux monitoring in patients with and without HH, including intermittent HH.

Methods: All patients evaluated with HRM and ambulatory reflux monitoring for persisting reflux symptoms at a tertiary care facility over a 5 year period were eligible for inclusion. All HRM were re-analyzed by an investigator (SG) not involved in clinical management. Esophagogastric junction (EGJ) morphology was assessed as the relationship between the lower esophageal sphincter (LES) and crural diaphragm (CD) as follows: no separation=no HH (type 1 EGJ); separation for part but not the entire HRM=intermittent HH; persistent separation=HH (type 2 EGJ:< 3 cm separation; type 3 EGJ: ≥3 cm separation). Reflux metrics were categorized as abnormal when total acid exposure time (AET) >6%, upright AET >6%, supine AET >2. Comparative analyses were performed to determine esophageal reflux burden based on EGJ morphology.

Results: 40 patients (median 52.5 years, 68% F) fulfilled criteria thus far in this ongoing study. Presenting symptoms were typical reflux symptoms (heartburn, regurgitation) in 36 patients, atypical symptoms of suspected reflux etiology in 3 patients and 1 had dysphagia. HRM evidence of type 2/3 EGJ (persistent HH) was noted in 11 patients (27.5%), and intermittent HH in 7 (17.5%). Intermittent HH was associated with similar proportions of patients with abnormal total AET as persistent HH (p=0.14), and both HH groups had significantly higher proportions compared to intact EGJ (Table, p=0.004). Median AET values were 5.0% (IQR 2.1%-14.4%) in no HH (p≥0.07 vs. HH groups), 11.8% (IQR 2.6%-17.4%) in intermittent HH, and 10.5% (IQR 9.9%-13.0%) in persistent HH. Abnormal upright and supine AET followed similar trends. Proportions of patients with a hypotensive EGJ and hypomotility disorders were similar between groups (Table, p≥0.33).

Discussion: Our preliminary findings suggest that patients with an intermittent HH have esophageal reflux burden resembling that seen with a persistent HH; both have higher acid burden compared to an intact EGJ. Further research is needed to determine if management outcome varies by presence of intermittent vs. persistent HH.




Disclosures:


Surosree Ganguli, MD¹, Samantha Zarro, MD², Janki Luther, MD, MPH³, C. Prakash Gyawali, MD, MRCP, FACG³, Farid Kehdy, MD¹, Benjamin Rogers, MD¹. P0293 - Intermittent Hiatus Hernia on High Resolution Manometry Associates With Reflux Metrics Similar to Persistent Hiatus Hernia, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.