Correlation Between Clinical Symptoms Of Gastroesophageal Reflux Disease(GERD) And Esophageal Hiatal Hernia

[Objective]Gastroesophageal reflux disease(GERD)is associated with structural disruption of the cardia valve in the gastroesophageal junction region,and hiatal hernia disrupts the cardia valve.This study is intended to explore the effect of the change in spatial volume of hiatal hernia on the anti-reflux barrier and its relevance to the intraesophageal symptoms of gastroesophageal reflux disease(GERD).The study was conducted to further investigate the pathogenesis of gastroesophageal reflux disease(GERD)and to provide new ideas for the diagnosis and treatment of GERD(gastroesophageal reflux disease).[Methods]A retrospective analysis of 69 patients with gastroesophageal reflux disease(GERD)treated minimally invasively at Yan’an Hospital of Kunming Medical University between January 2020 and January 2021 was performed.Anti-reflux surgery was performed after completing preoperative history and preoperative examinations such as CT,gastroscopy,and orthopantomolecular chest DR.During surgery,R(radius),S(transverse diameter)and L(longitudinal depth)of the patient’s esophageal fissure were measured to calculate the hiatal surface area,and the longitudinal depth and hiatal surface area were used to calculate the spatial defect of the esophageal fissure.The relationship with the typical symptoms of GERD(acid reflux,regurgitation,eructation,heartburn,etc.)and atypical symptoms of GERD(chest pain,back pain,epigastric pain,vomiting,etc.)was analyzed,and the validity of preoperative examination was analyzed.[Results]All 69 patients successfully completed the anti-reflux surgery without major postoperative complications.The radius length was measured from 1cm to 8cm,with an average of 3.59cm;the transverse length was measured from 1cm to 6cm,with an average of 2.63cm.The area of the esophageal fissure was calculated from 0.765cm2 to 20.340cm2,with an average of 5.460cm2;the longitudinal length was measured from 1cm to 13cm,with an average of 3.73cm.The volume of the esophageal fissure defect space was calculated from 1.01 cm3 to 264.42 cm3,with an average of 23.79 cm3;58 patients(84.1%)of 69 cases showed typical symptoms and 11 patients(15.9%)showed only atypical symptoms.There was a significant difference between patients showing typical symptoms and those showing only atypical symptoms in terms of both longitudinal depth and defect volume(P<0.05),while there was no significant difference in area size(P=0.218).There was no correlation between preoperative body mass index and intraoperative measurements of esophageal fissure area,longitudinal depth,and volume(P>0.05).In 69 patients with gastroesophageal reflux disease(GERD),17 cases of hiatal hernia were detected by CT,with a detection rate of 22%.When the esophageal fissure volume was greater than 16 cm3,15 cases were detected by CT,while when the esophageal fissure volume was less than 16 cm3,only 2 cases were detected by CT,which had significant differences.[Conclusion].1.The larger the esophageal fissure space defect is5 the more likely patients have atypical symptoms of gastroesophageal reflux disease(GERD).2.When the esophageal fissure defect is larger and the longitudinal depth of the esophageal fissure is shorter.Such findings may be related to the reconstitution of GEFV above the diaphragm.3.Patients with typical symptoms of GERD without detecting HH may have failed to detect the space defect above the diaphragm due to the limitations of the examination modality.