ROLE OF HIATAL-HERNIA IN DELAYING ACID CLEARANCE

The aim of this study was to assess prospectively the relationship of a hiatal hernia to gastro-oesophageal reflux. Ninety five children wit h symptoms of gastro-oesophageal reflux in whom reflux was demonstrate d radiologically were investigated. Oesophageal pH monitoring for 18 h ours and endoscopy were performed in all patients. On the basis of rad iology, patients were divided into those with hiatal hernia (n = 37) a nd those without (n = 58). Both groups had the same number of reflux e pisodes on pH monitoring. However, the median duration of the longest episode was significantly greater in the hiatal hernia group (30 min v 19 min), as was the number of reflux episodes longer than five minute s (5 v 4). The percentage with a pH<4 just failed to be significantly different (13% v 8%). Hiatal hernia was also found to correlate with t he presence of oesophagitis. The presence of a hiatal hernia delays th e clearance of acid from the oesophagus and is associated with an incr eased incidence of oesophagitis.