PREVALENCE OF HIATAL-HERNIA AND ITS INFLUENCE ON GASTROESOPHAGEAL REFLUX

Objective: To evaluate whether the presence of a sliding hiatal hernia influences gastro-oesophageal reflux (GOR) and treatment outcome in p atients with GOR disease. Patients: The study included 197 outpatients referred for oesophagoscopy and oesophageal pH-monitoring because of typical GOR symptoms. Results: Following the above two tests, the pati ents were divided into four groups: 64 patients were found to have bot h oesophagitis and pathological acid reflux, 84 patients proved to hav e neither, 37 had pathological reflux but no oesophagitis, and 12 had endoscopic oesophagitis without pathological GOR. Hiatal hernia was fo und in 35 (54.7%), 19 (22.6%), 11 (29.7%) and six (5.0%) patients in t he four groups, respectively. When the results of 24-h pH-monitoring w ere compared between patients with and without hiatal hernia, a statis tically significant difference was found in the group with pathologica l reflux and hiatal hernia, who experienced a longer percentage time w ith supine reflux and a higher frequency of episodes lasting more than 5 min at night (P<0.05). When patients with and without hiatal hernia were compared, significantly more patients with hiatal hernia were fo und to be combined refluxers, i.e. they experienced reflux during both the day and night. Conclusions: Hiatal hernia occurs more frequently in patients with reflux oesophagitis than in those without. When patho logical reflux is not accompanied by oesophagitis, reflux is significa ntly less marked in the absence than in the presence of hiatal hernia. Patients with hiatal hernia reflux more frequently than those without .