A hiatal hernia (HH) is a frequent finding in patients with gastroesophageal reflux disease (GERD). We examined a consecutive series of patients with GERD diagnosed by a 24-hour pH monitoring. Based on the presence and size of HH on barium swallow, patients were divided into the following groups: no HH, HH <3 cm, HH 3–5 cm and HH >5 cm. A total of 175 patients were included: 43 with no HH, 86 with HH <3 cm, 34 with HH 3–5 cm, and 12 with HH >5 cm. Patients with larger HH had more frequent episodes of coughing and wheezing associated with episodes of reflux. High-resolution manometry showed that the increasing size of the HH was associated with decreasing pressure of the lower esophageal sphincter and weaker peristalsis. Ambulatory pH monitoring revealed that patients with larger HH had more acid reflux, in both the distal and proximal esophagus. Endoscopy showed that patients with larger HH had more severe esophagitis. Fifty per cent of patients with HH >5.0 cm had Barrett's esophagus. These findings should guide gastroenterologists and surgeons in choosing the appropriate therapy in patients with GERD and large HH.
Get full access to this article
View all access options for this article.
References
1.
El-SeragH.B., SweetS., WinchesterC.C.Update on the epidemiology of gastro-esophageal reflux disease: a systematic review.Gut2014; 63: 871–80.
KahrilasP.J., DoddsW.J., HoganW.J.Effect of peristaltic dysfunction on esophageal volume clearance.Gastroenterology1988; 94: 73–80.
4.
AyaziS., DeMeesterS.R., HsiehC.C.Thoraco-abdominal pressure gradients during the phases of respiration contribute to gastroesophageal reflux disease.Dig Dis Sci2011; 56: 1718–22.
5.
GordonC., KangJ.Y., NeildP.J.The role of the hiatus hernia in gastro-oesophageal reflux disease.Aliment Pharmacol Ther2004; 20: 719–32.
6.
MittalR.K., RochesterD.F., McCallumR.W.Effect of the diaphragmatic contraction on lower oesophageal sphincter pressure in man.Gut1987; 28: 1564–8.
7.
ShaheenN.J., FalkG.W., IyerP.G.ACG clinical guideline: diagnosis and management of Barrett's esophagus.Am J Gastroenterol2016; 111: 30–50.
LacyB.E.1, TalleyN.J., LockeG.R.3rd. Review article: current treatment options and management of functional dyspepsia.Aliment Pharmacol Ther2012; 36: 3–15.
10.
PattiM.G., DienerU., TamburiniA.Role of esophageal function tests in diagnosis of gastroesophageal reflux disease.Dig Dis Sci2001; 46: 597–602.
11.
NothI., ZanganS.M., SoaresR.V.Prevalence of hiatal hernia by blinded multidetector CT in patients with idiopathic pulmonary fibrosis.Eur Respir J2012; 39: 344–51.
12.
McDonnellM.J., AhmedM., DasJ.Hiatal hernias are correlated with increased severity of non-cystic fibrosis bronchiectasis.Respirology2015; 20: 749–57.
13.
FeinM., RitterM.P., DeMeesterT.R.Role of the lower esophageal sphincter and hiatal hernia in the pathogenesis of gastroesophageal reflux disease.J Gastrointest Surg1999; 3: 405–10.
14.
KahrilasP.J., LinS., ChenJ.The effect of hiatus hernia on gastro-oesophageal junction pressure.Gut1999; 44: 476–82.
15.
PattiM.G., GoldbergH.I., ArceritoM.Hiatal hernia size affects lower esophageal sphincter function, esophageal acid exposure, and the degree of mucosal injury.Am J Surg1996; 171: 182–6.
16.
DeMeesterT.R., LafontaineE., JoelssonB.E.Relationship of a hiatal hernia to the function of the body of the esophagus and the gastroesophageal junction.J Thorac Cardiovasc Surg1981; 82: 547–58.
17.
OttD.J., GlauserS.J., LedbetterM.S.Association of hiatal hernia and gastroesophageal reflux: correlation between presence and size of hiatal hernia and 24-hour pH monitoring of the esophagus.AJR Am J Roentgenol1995; 165: 557–9.
18.
MittalR.K., LangeR.C., McCallumR.W.Identification and mechanism of delayed esophageal acid clearance in subjects with hiatus hernia.Gastroenterology1987; 92: 130–5.
19.
SloanS., KahrilasP.J.Impairment of esophageal emptying with hiatal hernia.Gastroenterology1991; 100: 596–605.
20.
des VarannesS.B., MionF., DucrottéP.Simultaneous recordings of oesophageal acid exposure with conventional pH monitoring and a wireless system (Bravo).Gut2005; 54: 1682–6.
21.
IqbalA., LeeY.K., VitamvasM.48-hour pH monitoring increases the risk of false positive studies when the capsule is prematurely passed.J Gastrointest Surg2007; 11: 638–41.
22.
SontagS.J., SchnellT.G., MillerT.Q.The importance of hiatal hernia in reflux esophagitis compared with lower esophageal sphincter pressure or smoking.J Clin Gastroenterol1991; 13: 628–43.
23.
JonesM.P., SloanS.S., JovanovicB.Impaired egress rather than increased access: an important independent predictor of erosive oesophagitis.Neurogastroenterol Motil2002; 14: 625–31.
24.
JonesM.P., SloanS.S., RabineJ.C.Hiatal hernia size is the dominant determinant of esophagitis presence and severity in gastroesophageal reflux disease.Am J Gastroenterol2001; 96: 1711–7.
25.
WuA.H., TsengC.C., BernsteinL.Hiatal hernia, reflux symptoms, body size, and risk of esophageal and gastric adenocarcinoma.Cancer2003; 98: 940–8.
26.
LordR.V., DeMeesterS.R., PetersJ.H.Hiatal hernia, lower esophageal sphincter incompetence, and effectiveness of Nissen fundoplication in the spectrum of gastroesophageal reflux disease.J Gastrointest Surg2009; 13: 602–10.
27.
AvidanB., SonnenbergA., SchnellT.G.Hiatal hernia size, Barrett's length, and severity of acid reflux are all risk factors for esophageal adenocarcinoma.Am J Gastroenterol2002; 97: 1930–6.
28.
WestonA.P., BadrA.S., HassaneinR.S.Prospective multivariate analysis of clinical, endoscopic, and histological factors predictive of the development of Barrett's multifocal high-grade dysplasia or adenocarcinoma.Am J Gastroenterol1999; 94: 3413–9.
