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Hiatal hernias: a review of the pathophysiologic theories and implication for research. Surg Endosc 2011 Oct;25(10):3149-53

Date

04/30/2011

Pubmed ID

21528392

DOI

10.1007/s00464-011-1725-y

Scopus ID

2-s2.0-84856172010   24 Citations

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.

Author List

Weber C, Davis CS, Shankaran V, Fisichella PM

Author

Christopher Stephen Davis MD, MPH Assistant Professor in the Surgery department at Medical College of Wisconsin




MESH terms used to index this publication - Major topics in bold

Esophagogastric Junction
Gastroesophageal Reflux
Hernia, Hiatal
Humans
Risk Factors
jenkins-FCD Prod-482 91ad8a360b6da540234915ea01ff80e38bfdb40a