{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T13:06:18Z","timestamp":1792587978373,"version":"4.5.0"},"reference-count":41,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2022,5,20]],"date-time":"2022-05-20T00:00:00Z","timestamp":1653004800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Neurogastroenterology Motil"],"published-print":{"date-parts":[[2022,11]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Hiatus hernia (HH) contributes to development of gastroesophageal reflux disease, Barrett's esophagus and esophageal adenocarcinoma. This study was aimed to investigate the influence of HH on reflux patterns and distal esophageal mucosal integrity in non\u2010erosive reflux disease (NERD).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We retrospectively analyzed PPI\u2010refractory NERD patients referred to three tertiary referral centers who underwent high\u2010resolution manometry and off\u2010PPI 24\u2010h impedance\u2010pH monitoring (with or without bile spectrophotometry). Patients with HH \u22652\u00a0cm (HH group, <jats:italic>n<\/jats:italic>\u00a0=\u00a042) or no HH (non\u2010HH group, <jats:italic>n<\/jats:italic>\u00a0=\u00a040) with similar esophageal acid exposure time (AET 6%\u201312%) were included.<\/jats:p><\/jats:sec><jats:sec><jats:title>Key Results<\/jats:title><jats:p>Age, gender, BMI, esophageal motility, AET, and esophageal clearance were similar between the two groups. The HH group had higher numbers of total reflux episodes (<jats:italic>p<\/jats:italic>\u00a0=\u00a00.015) with similar proportion of acid\/non\u2010acid reflux compared with the non\u2010HH group. Mean nocturnal baseline impedance (MNBI) in the distal esophagus was significantly lower in the HH group than the non\u2010HH group at both 5\u00a0cm (<jats:italic>p<\/jats:italic>\u00a0=\u00a00.002) and 3\u00a0cm (<jats:italic>p<\/jats:italic>\u00a0=\u00a00.015) above the lower esophageal sphincter. Multivariable regression analysis showed that HH, less non\u2010acid reflux and lower post\u2010reflux swallow\u2010induced peristaltic wave index (PSPWI) were independently associated with lower MNBI. Among 31 patients tested with bile spectrophotometry, the HH group had significantly longer bile exposure time than the non\u2010HH group (<jats:italic>p<\/jats:italic>\u00a0=\u00a00.011), and bile reflux inversely and significantly correlated with MNBI (rho\u00a0=\u00a0\u22120.75, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions and Inferences<\/jats:title><jats:p>Hiatus hernia, less non\u2010acid reflux and lower PSPWI were associated with lower MNBI. HH impairs distal esophageal mucosal integrity, the mechanism of which we speculate to be through excessive bile reflux.<\/jats:p><\/jats:sec>","DOI":"10.1111\/nmo.14412","type":"journal-article","created":{"date-parts":[[2022,5,20]],"date-time":"2022-05-20T09:40:12Z","timestamp":1653039612000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Effect of hiatus hernia on reflux patterns and mucosal integrity in patients with non\u2010erosive reflux disease"],"prefix":"10.1111","volume":"34","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0590-3693","authenticated-orcid":false,"given":"Akinari","family":"Sawada","sequence":"first","affiliation":[{"name":"Wingate Institute of Neurogastroenterology, Blizard Institute, Barts and The London School of Medicine and Dentistry Queen Mary University of London  London UK"},{"name":"Department of Gastroenterology Osaka City University Graduate School of Medicine  Osaka Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin","family":"Rogers","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology Washington University School of Medicine  St. Louis Missouri USA"},{"name":"Division of Gastroenterology, Hepatology and Nutrition University of Louisville  Louisville Kentucky USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pierfrancesco","family":"Visaggi","sequence":"additional","affiliation":[{"name":"Gastroenterology Unit Department of Translational Research and New Technologies in Medicine and Surgery University of Pisa  Pisa Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1995-1060","authenticated-orcid":false,"given":"Nicola","family":"de Bortoli","sequence":"additional","affiliation":[{"name":"Gastroenterology Unit Department of Translational Research and New Technologies in Medicine and Surgery University of Pisa  Pisa Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3388-0660","authenticated-orcid":false,"given":"C. Prakash","family":"Gyawali","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology Washington University School of Medicine  St. Louis Missouri USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4894-0523","authenticated-orcid":false,"given":"Daniel","family":"Sifrim","sequence":"additional","affiliation":[{"name":"Wingate Institute of Neurogastroenterology, Blizard Institute, Barts and The London School of Medicine and Dentistry Queen Mary University of London  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2022,5,20]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1572-0241.2006.00630.x"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cgh.2020.03.057"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.3109\/00365529108996243"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2036.2006.03040.x"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1572-0241.1999.01277.x"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1440-1746.2012.07199.x"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1136\/gut.44.4.476"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0016-5085(03)01210-1"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF02220466"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/0016-5085(91)80003-R"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/0016-5085(87)90849-3"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1136\/gut.2009.178061"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2036.2011.04664.x"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.1053\/gast.1996.v111.pm8898632"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.1111\/nmo.14058"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.1111\/nmo.13104"},{"key":"e_1_2_9_18_1","doi-asserted-by":"publisher","DOI":"10.1136\/gutjnl-2017-314722"},{"key":"e_1_2_9_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cgh.2020.09.002"},{"key":"e_1_2_9_20_1","doi-asserted-by":"publisher","DOI":"10.1111\/nmo.12080"},{"key":"e_1_2_9_21_1","doi-asserted-by":"publisher","DOI":"10.5056\/jnm19183"},{"key":"e_1_2_9_22_1","doi-asserted-by":"publisher","DOI":"10.1111\/nmo.12947"},{"key":"e_1_2_9_23_1","doi-asserted-by":"publisher","DOI":"10.1136\/gutjnl-2020-322627"},{"key":"e_1_2_9_24_1","doi-asserted-by":"publisher","DOI":"10.1177\/2050640618769160"},{"key":"e_1_2_9_25_1","doi-asserted-by":"publisher","DOI":"10.1111\/nmo.12507"},{"key":"e_1_2_9_26_1","doi-asserted-by":"publisher","DOI":"10.14309\/ajg.0000000000000734"},{"key":"e_1_2_9_27_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2982.2006.00825.x"},{"key":"e_1_2_9_28_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2021.07.004"},{"key":"e_1_2_9_29_1","doi-asserted-by":"publisher","DOI":"10.1136\/gut.2010.233049"},{"key":"e_1_2_9_30_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cgh.2019.05.044"},{"key":"e_1_2_9_31_1","doi-asserted-by":"publisher","DOI":"10.1136\/gut.2007.141804"},{"key":"e_1_2_9_32_1","doi-asserted-by":"publisher","DOI":"10.1111\/nmo.13919"},{"key":"e_1_2_9_33_1","doi-asserted-by":"publisher","DOI":"10.1111\/apt.13777"},{"key":"e_1_2_9_34_1","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0b013e31823899f8"},{"key":"e_1_2_9_35_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2036.2010.04502.x"},{"key":"e_1_2_9_36_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-9610(99)80096-8"},{"key":"e_1_2_9_37_1","doi-asserted-by":"publisher","DOI":"10.1159\/000094525"},{"key":"e_1_2_9_38_1","doi-asserted-by":"publisher","DOI":"10.1016\/0016-5085(86)90692-X"},{"key":"e_1_2_9_39_1","doi-asserted-by":"publisher","DOI":"10.1007\/s005350200031"},{"key":"e_1_2_9_40_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11605-011-1619-2"},{"key":"e_1_2_9_41_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2036.2006.02816.x"},{"key":"e_1_2_9_42_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-2982.2002.00362.x"}],"container-title":["Neurogastroenterology &amp; 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