The stomach and gastric function
Paul Ong, Rachel Skittrall in Gastrointestinal Nursing, 2017
A hiatus hernia is the upward escape of the stomach through the hiatus of the diaphragm to lie within the chest. There are two main types of hiatus hernia: sliding and para-oesophageal or rolling. Sliding hiatus hernia is the most common of the two occurring in almost 95% of cases (Fofaria and Morris, 2015) and is associated with reflux. In this situation the top of the stomach protrudes through the hole in the diaphragm called the oesophageal hiatus. This hiatus, or hole, is what allows the oesophagus to enter the thoracic cavity and join the stomach in the abdominal cavity at the gastro-oesophageal junction (GOJ). The hernia may slide up and down, disrupting the GOJ (Figure 4.7). The oesophageal hiatus may dilate, with laxity of the phreno-oesphageal ligament.
The upper gastrointestinal tract, common conditions, and recommended treatments
Simon R. Knowles, Laurie Keefer, Antonina A. Mikocka-Walus in Psychogastroenterology for Adults, 2019
Hiatus hernia refers to the situation in which the top of the stomach slides up through the diaphragm into the chest (Figure 2.1). This is believed to be due to laxity of the structures that hold the stomach in place in the abdomen. Hiatus hernia may be asymptomatic but is often associated with GORD (see later) and, if very large may be associated with mechanical symptoms such as vomiting or difficulty breathing. Unless symptomatic, the presence of a hiatus hernia does not necessitate treatment, which requires surgery, rather the associated condition (usually reflux) is managed and, if that requires surgery, the hiatus hernia is repaired as part of the operation. For more information about hiatus hernia see [6].
Building the patient profile
Stephanie Martin in Working with Voice Disorders, 2020
It is well recognised that reflux is of importance in the general condition of the vocal folds, as previously noted in Chapter 2. Any spillage of acid reflux into the larynx may result in irritation to, or inflammation of, the mucosal linings. Subsequent alteration in vibration characteristics and voice often leads to increased effort to overcome the hoarseness. Although some patients may be aware of digestive difficulty, this may not always be so and some patients have undiagnosed and untreated reflux until they are assessed by the voice clinician. Hiatus hernia may create similar reflux problems or intermittent pain leading to inhibited movement of the diaphragm. Various types of foods may be contributory factors in leading to thick saliva and dryness of the mouth. For instance, spicy foods may result in thirst and a dry mouth and while foods such as milk, cheese, and yogurt do not trigger the body to produce excess mucus, they can cause existing mucus to become thicker. With dryness of the mouth and thick secretions, it is likely that the patient will clear the throat more regularly to eliminate the tenacious secretions, resulting in irritation in the larynx. An additional consideration should be the possibility of a patient presenting with reflux as a result of unreported bulimia where patients experience digestive problems, including acid reflux and stomach pain. The sphincter controlling the oesophagus may become weaker, due to continued bouts of vomiting allowing acid to back up into the oesophagus and causing gastrointestinal symptoms. Anorexia may also cause voice quality changes, but those changes are more often the result of the effect of the process of starvation on most organ systems and the subsequent connection to anatomy, physiology, neuroanatomy and psychology than a direct effect on the vocal tract per se.
Clinical characteristics of reflux esophagitis among patients with liver cirrhosis: a case-control study
Published in Scandinavian Journal of Gastroenterology, 2022
Zijin Liu, Lin Wei, Huiguo Ding
Erosive esophagitis was diagnosed based on the Los Angeles (LA) classification [19]. Additionally, the presence of Barrett’s epithelium was defined as the macroscopic identification of abnormal columnar esophageal epithelium more than 1 cm in thickness, which is suggestive of a columnar-lined distal esophagus. Hiatus hernia was defined if the proximal dislocation of the gastroesophageal junction was >2 cm above the diaphragmatic indentation. Esophageal varices were graded as mild, medium or severe. Mild EVs were defined as varicose veins that were straight or mildly tortuous without a red color (RC) sign. Medium EVs were defined as varicose veins that were serpentine without an RC sign or varicose veins that were mildly tortuous with an RC sign. Severe EVs were defined as varicose veins that were serpentine with an RC sign or varicose veins that were toruliform. Portal hypertension gastropathy (PHG) was defined as snakeskin-like mucosa, flat or bulging red marks or red spots resembling vascular ectasias found in the stomach. Helicobacter pylori (HP) infection was evaluated by mucous biopsy or 13C-urea-breath tests.
Oesophageal motor disorders and oesophageal endoscopic involvement in patients with systemic sclerosis: a systematic association?
Published in Scandinavian Journal of Gastroenterology, 2021
Véronique Vitton, Camille Bazin, Laure Luciano, Brigitte Granel, Marine Alessandrini, Jean-Robert Harle
UGIE was systematically carried out under general anaesthetic, in one of the endoscopic centres of the Marseilles Public Hospitals. PPI were systematically stopped at least 15 days before performing the UGIE. The presence of hiatus hernia as well as any other macroscopic or histological anomaly was noted. Oesophagitis was scored according to the Los Angeles classification [21]: Grade A, presence of one or several mucosal breaks limited to the mucosal fold(s) and no larger than 5 mm in extent, Grade B, presence of at least one mucosal break exceeding 5 mm in extent but limited to the mucosal fold(s), with no extension over the folds, Grade C, presence of at least one mucosal break, extending over the mucosal folds, but over less than 75% of the circumference and Grade D, confluent mucosal breaks extending over more than 75% of the circumference.
Oesophageal screening during videofluoroscopy: International practices and perspectives of speech-language pathologists
Published in International Journal of Speech-Language Pathology, 2020
Julie Regan, Teresa Wiesinger, Julie Keane, Margaret Walshe
During swallowing, a bolus passes from the oral cavity into the stomach. A breakdown anywhere along this continuum can cause dysphagia and this alteration can impact on other stages of swallowing (Jones, Donner, Rubesin, Ravich, & Hendrix, 1987; Jones, Ravich, Donner, Kramer, & Hendrix, 1985). The interrelationship between the oropharyngeal and oesophageal phases of swallowing has become more apparent with the emergence of high-resolution impedance manometry (HRIM) (Butler, Nekl, Rees, Leng, & Lever, 2010; O’Rourke et al., 2014) and this strong association explains why oropharyngeal and oesophageal phase dysphagia frequently co-exist. Oesophageal conditions such as achalasia and eosinophilic oesophagitis can cause pharyngeal dysphagia (Jones et al., 1987; Murray, Joyce, Palmer, Lau, & Schultz, 2016). Clear associations have also been made between hiatus hernia and gastro-oesophageal reflux disease and cricopharyngeal dysfunction (Dantas & Cassiani, 2019; Native-Zeltzer, Rameau, Kuhn, Kauf, & Belafsky, 2018). Individuals with oesophageal and oesopho-gastric carcinoma frequently present with symptoms of pharyngeal dysphagia (Dai et al., 2014).
Related Knowledge Centers
- Chest Pain
- Dysphagia
- Heartburn
- Hernia
- Abdomen
- Stomach
- Mediastinum
- Thoracic Diaphragm
- Gastroesophageal Reflux Disease
- Laryngopharyngeal Reflux