Barrett's esophagus: Prevalence and size of hiatal hernia

OBJECTIVE: Barrett's esophagus is caused by gastroesophageal reflux and pre disposes to adenocarcinoma. Hiatal hernia may cause reflux. The prevalence and size of hernias in patients with Barrett's esophagus was investigated. METHODS: Axial hernia length and the width of the diaphragmatic hiatus were measured prospectively at endoscopy. RESULTS: A 2-cm or longer hernia was found in 96% of 46 patients with Barre tt's esophagus, in 42% of 103 controls (p < 0.001), and in 72% of 18 patien ts with short segment Barrett's esophagus (p < 0.05 vs controls). A hernia was found in 71% of 31 controls with esophagitis and in 29% of 72 controls without esophagitis (p < 0.001). Of 54 controls with neither esophagitis or reflux symptoms, 20% had a hernia. Mean hernia length was 3.95 cm in Barre tt's esophagus, and 2.81 cm in controls (p < 0.005). Mean hiatus width was 3.52 cm in patients with Barrett's esophagus and hernia, and 2.24 cm in con trols with hernia. Hernia length was similar in patients with and without e sophagitis, and in short segment Barrett's esophagus. CONCLUSIONS: Most patients with Barrett's esophagus have hiatal hernia; the ir hernias are longer and the hiatal openings wider than in controls with o r without esophagitis. Hiatal hernia likely contributes to the development of Barrett's esophagus. (Am J Gastroenterol 1999;94:2054-2059. (C) 1999 by Am. Coll. of Gastroenterology).