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Surgical Endoscopy

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01-10-2011 | Review

Hiatal hernias: a review of the pathophysiologic theories and implication for research

Authors: C. Weber, C. S. Davis, V. Shankaran, P. M. Fisichella

Published in: Surgical Endoscopy | Issue 10/2011

Abstract

Background

The pathophysiology of hiatal hernias is incompletely understood. This study systematically reviewed the literature of hiatal hernias to provide an evidence-based explanation of the pathogenetic theories and to identify any risk factors at the molecular and cellular levels.

Methods

A systematic search of the Medline and Pubmed databases on the pathophysiology of hiatal hernias was performed to identify English-language citations from the database inception to December 2010.

Results

Although few studies have examined the relationship of molecular and cellular changes of the diaphragm to the pathogenesis of hiatal hernias, there appear to be three dominant pathogenic theories: (1) increased intraabdominal pressure forces the gastroesophageal junction (GEJ) into the thorax; (2) esophageal shortening due to fibrosis or excessive vagal nerve stimulation displaces the GEJ into the thorax; and (3) GEJ migrates into the chest secondary to a widening of the diaphragmatic hiatus in response to congenital or acquired molecular and cellular changes, such as the abnormalities of collagen type 3 alpha 1.

Conclusions

The pathogenesis of hiatal hernias at the molecular and cellular levels is poorly described. To date, no single theory has proved to be the definitive explanation for hiatal hernia formation, and its pathogenesis appears to be multifactorial.

Morison JMW (1930) Diaphragmatic hernia. Proc R Soc Med 23:1615–1634PubMed

Stylopoulos N, Rattner DW (2005) The history of hiatal hernia surgery: from Bowditch to laparoscopy. Ann Surg 241:185–193PubMed

Morgagni GB (1769) The seats and causes of diseases investigated by anatomy, vol 3. Miller and Cadell, London, p 205

Bowditch HI (1853) A treatise on diaphragmatic hernia. Jewett Thomas, Buffalo, NY

Schwarz GS (1967) Historical aspects of the anatomy of the cardia with special reference to hiatus hernia. Bull N Y Acad Med 43:112–125PubMed

Eppinger H (1911) Allgemeine und spezielle Pathologie des Zwerchfells. In: Frankl-Hochwart L (ed) Supplemente zu H. Nothnagel, Spezielle Pathologie und Therapie. Holder, Wien

Harrington SW (1945) The surgical treatment of the more common types of diaphragmatic hernia: esophageal hiatus, traumatic, pleuroperitoneal hiatus, congenital absence and foramen of Morgagni: report of 404 cases. Ann Surg 122:546–568PubMedCrossRef

Soresi AL (1919) Diaphragmatic hernia: its unsuspected frequency: diagnosis and technique for radical cure. Ann Surg 69:254–270PubMedCrossRef

Robins SA, Jankelson IR (1926) Cardioesophageal relaxation. JAMA 87:1961–1964

10.

Akerlund A, Onnell H, Key E (1926) Hernia diaphragmatica hiatus oesophagei vom anastomischen und roentgenologischen gesichtspunkt. Acta Radiol 6:3–22CrossRef

11.

Pandolfino JE, El-Serag HB, Zhang Q, Shah N, Ghosh SK, Kahrilas PJ (2006) Obesity: a challenge to esophagogastric junction integrity. Gastroenterology 130:639–649PubMedCrossRef

12.

Christensen J, Miftakhov R (2000) Hiatus hernia: a review of evidence for its origin in esophageal longitudinal muscle dysfunction. Am J Med 108:3S–7SPubMedCrossRef

13.

Curci JA, Melman LM, Thompson RW, Soper NJ, Matthews BD (2008) Elastic fiber depletion in the supporting ligaments of the gastroesophageal junction: a structural basis for the development of hiatal hernia. J Am Coll Surg 207:191–196PubMedCrossRef

14.

Rosch R, Klinge U, Si Z, Junge K, Klosterhalfen B, Schumpelick V (2002) A role for collagen I/III and MMP-1/13 genes in primary inguinal hernia? BMC Med Genet 3:1–6CrossRef

15.

Si Z, Bhardwaj R, Rosch R, Mertens PR, Klosterhalfen B, Klinge U (2002) Impaired balance of type I and type III procollagen mRNA in cultured fibroblasts of patients with incisional hernia. Surgery 131:324–331PubMedCrossRef

16.

Klinge U, Si ZY, Zheng H, Schumpelick V, Bhardwaj RS, Klosterhalfen B (2001) Collagen I/III and matrix metalloproteinases (MMP) 1 and 13 in the fascia of patients with incisional hernias. J Invest Surg 13:47–54

17.

Zheng H, Si Z, Kasperk R et al (2002) Recurrent inguinal hernia: disease of collagen matrix? World J Surg 26:401–408PubMedCrossRef

18.

Wagh PV, Leverich AP, Sun CN, White HJ, Read RC (1974) Direct inguinal herniation in men: a disease of collagen. J Surg Res 17:425–433PubMedCrossRef

19.

Asling B, Jirholt J, Hammond P, Knutsson M, Walentinsson A, Davidson G, Agreus L, Lehmann A, Lagerström-Fermer M (2009) Collagen type III alpha I is a gastro-oesophageal reflux disease susceptibility gene and a male risk factor for hiatus hernia. Gut 58:1063–1069PubMedCrossRef

20.

Hovsepian DM, Ziporin SJ, Sakurai MK, Lee JK, Curci JA, Thompson RW (2000) Elevated plasma levels of matrix metalloproteinase-9 in patients with abdominal aortic aneurysms: a circulating marker of degenerative aneurysm disease. J Vasc Intervent Radiol 11:1345–1352CrossRef

21.

Molet S, Belleguic C, Lena H, Germain N, Bertrand CP, Shapiro SD, Planquois JM, Delaval P, Lagente V (2005) Increase in macrophage elastases (MMP-12) in lungs from patients with chronic obstructive pulmonary disease. Inflam Res 54:31–36CrossRef

22.

Bellón JM, Bajo A, Ga-Honduvilla N, Gimeno MJ, Pascual G, Guerrero A, Buján J (2001) Fibroblasts from the transversalis fascia of young patients with direct inguinal hernias show constitutive MMP-2 overexpression. Ann Surg 233:287–291PubMedCrossRef

23.

Melman L, Chisholm PR, Curci JA, Arif B, Pierce R, Jenkins ED, Brunt LM, Eagon C, Frisella M, Miller K, Matthews BD (2010) Differential regulation of MMP-2 in the gastrohepatic ligament of the gastroesophageal junction. Surg Endosc 24:1562–1565PubMedCrossRef

24.

Fei L, del Genio G, Rossetti G, Sampaolo S, Moccia F, Trapani V, Cimmino M, del Genio A (2009) Hiatal hernia recurrence: surgical complication or disease? Electron microscope findings of the diaphragmatic pillars. J Gastrointest Surg 13:459–464PubMedCrossRef

25.

Fei L, del Genio G, Brusciano L, Esposito V, Cuttitta D, Pizza F, Rossetti G, Trapani V, Filippone G, Moccia F, del Genio A (2007) Crura ultrastructural alterations in patients with hiatal hernia: a pilot study. Surg Endosc 21:907–911CrossRef

Title: Hiatal hernias: a review of the pathophysiologic theories and implication for research
Authors: C. Weber
C. S. Davis
V. Shankaran
P. M. Fisichella
Publication date: 01-10-2011
Publisher: Springer-Verlag
Published in: Surgical Endoscopy / Issue 10/2011
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-011-1725-y

At a glance: The STEP trials

Springer Medicine

Hiatal hernias: a review of the pathophysiologic theories and implication for research

Abstract

Background

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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