Hiatal hernia size affects lower esophageal sphincter function, esophageal acid exposure, and the degree of mucosal injury

https://doi.org/10.1016/S0002-9610(99)80096-8Get rights and content

Background

Since the role of a hiatal hernia in the pathophysiology of gastroesophageal reflux disease (GERD) has not been fully elucidated, we studied the effects of hiatal hernias on the function of the lower esophageal sphincter (LES) and esophageal acid clearance.

Patients and methods

Ninety-five consecutive patients with GERD diagnosed by 24-hour pH monitoring underwent upper gastrointestinal series (UGI), endoscopy, and esophageal manometry. Based on the presence (H+) or absence (H-) of a hiatal hernia on UGI series, they were divided into two groups: H+ (n = 51) and H- (n = 44). Then, using the size of the hiatal hernia, the H+ group was divided into three subgroups: I, H <3 cm (n = 31); II, H 3.0 to 5 cm (n = 14); and III, H >5 cm (n = 6).

Results

Esophageal manometry showed that patients with larger hiatal hernias (groups II and III) had a weaker and shorter LES and less effective peristalsis compared to patients with a small or no hiatal hernia. Prolonged pH monitoring showed that patients with larger hiatal hernias were exposed to more refluxed acid and had more severely abnormal acid clearance. Endoscopy showed more severe esophagltis among patients with GERD and hiatal hernia compared with GERD patients without hiatal hernia, and the degree of esophagitis was proportionate to the size of the hernia.

Conclusions

Among patients with proven GERD, those with a small hiatal hernia and those with no hiatal hernia had similar abnormalities of LES function and acid clearance. In patients with larger hiatal hernias, however, the LES was shorter and weaker, the amount of reflux was greater, and acid clearance was less efficient. Consequently, the degree of esophagitis was worse in the presence of a large hiatal hernia.

References (20)

There are more references available in the full text version of this article.

Cited by (184)

  • Aspiration Pneumonia and Related Syndromes

    2018, Mayo Clinic Proceedings
  • Reflux esophagitis, functional and non-functional

    2019, Best Practice and Research: Clinical Gastroenterology
    Citation Excerpt :

    In the patients evaluated with endoscopy because of dyspeptic symptoms, 42% of those with a hiatus hernia did not have esophagitis while 63% of patients with endoscopically confirmed esophagitis had hiatus hernia. Patients without a hiatus hernia or with a small hiatus hernia had similar abnormalities of lower esophageal sphincter function and acid clearance; however, patients with a large hiatus hernia showed shorter and weaker lower esophageal sphincter, greater reflux and less effective acid clearance [4]. It is possible that hiatus hernia might be the result of GERD and a contributing factor for advanced disease but not the initiator of the disease process.

View all citing articles on Scopus
View full text