ASSOCIATION OF HIATAL-HERNIA AND GASTROESOPHAGEAL REFLUX - CORRELATION BETWEEN PRESENCE AND SIZE OF HIATAL-HERNIA AND 24-HOUR PH MONITORINGOF THE ESOPHAGUS

OBJECTIVE. The relationship of hiatal hernia to gastroesophageal reflu x disease remains controversial. Previous endoscopic and radiologic st udies of hiatal hernia and reflux esophagitis have shown that hiatal h ernia is a poor predictor of the presence of endoscopic esophagitis, e specially for smaller hernias. Similar correlations with 24-hr pH moni toring have not been done, The purpose of this study was to determine if there is a correlation between the presence and size of hiatal hern ias and gastroesophageal reflux using 24-hr pH monitoring as a measure of the degree of reflux. MATERIALS AND METHODS. We reviewed the bariu m esophagograms and the results of pH monitoring of the esophagus in 3 19 patients (161 women and 158 men; mean age, 51 years). The presence and size of hiatal hernia were determined from the radiographic examin ation; size was categorized as ''minimal'' or ''larger'' (greater than or equal to 2 cm axial length). An abnormal result of pH monitoring w as defined as a pH less than 4 for 6% or more of the 24-hr observation time. RESULTS. Abnormal results of pH monitoring were found in 61 (31 %) of 199 patients with hiatal hernia compared with 21 (18%) of 120 pa tients without hiatal hernia (p < .05). Abnormal findings of pH monito ring were present in 33 (35%) of 95 patients with a larger hiatal hern ia versus 28 (27%) of 104 patients with a minimal hiatal hernia (p > . 05); a significant difference (p < .05) was observed when patients wit hout hiatal hernia were compared with those with a larger hiatal herni a. CONCLUSION. Most patients in this study had normal results of pH mo nitoring of the esophagus regardless of the presence or absence of hia tal hernia. However, patients with larger hiatal hernias were more lik ely to have abnormal findings on pH monitoring; hiatal hernias of mini mal size were a poorer predictor of the presence of abnormal gastroeso phageal reflux.