Brief Article
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World J Gastroenterol. Feb 14, 2014; 20(6): 1582-1584
Published online Feb 14, 2014. doi: 10.3748/wjg.v20.i6.1582
Is the severity of gastroesophageal reflux dependent on hiatus hernia size?
Thomas Franzén, Lita Tibbling
Thomas Franzén, Lita Tibbling, Faculty of Health and Sciences, Linköping University, Department of Surgery, Vrinnevi Hospital Norrköping, SE-601 82 Norrköping, Sweden
Author contributions: Franzén T and Tibbling L participated equally in the development, implementation and management of this project, and were equally involved in the writing of the manuscript.
Correspondence to: Thomas Franzén, MD, PhD, Faculty of Health and Sciences, Linköping University, Department of Surgery, Vrinnevi Hospital Norrköping, SE-601 82 Norrköping, Sweden. thomas.franzen@lio.se
Telephone: +46-10-1030000 Fax: +46-10-1043216
Received: June 4, 2013
Revised: September 26, 2013
Accepted: October 19, 2013
Published online: February 14, 2014
Processing time: 257 Days and 20.2 Hours
Abstract

AIM: To determine if the severity of gastroesophageal reflux disease is dependent on the size of a hiatus hernia.

METHODS: Seventy-five patients with either a small (n = 25), medium (n = 25) or large (n = 25) hiatus hernia (assessed by high resolution esophageal manometry) were investigated using 24-h esophageal monitoring and a self-assessed symptom questionnaire. The questionnaire comprised the following items, each graded from 0 to 3 according to severity: heartburn; pharyngeal burning sensation; acid regurgitation; and chest pain.

RESULTS: The percentage total reflux time was significantly longer in the group with hernia of 5 cm or more compared with the group with a hernia of < 3 cm (P < 0.002), and the group with a hernia of 3 to < 5 cm (P < 0.04). Pharyngeal burning sensation, heartburn and acid regurgitation were more common with large hernias than small hernias, but the frequency of chest pain was similar in all three hernia groups.

CONCLUSION: Patients with a large hiatus hernia are more prone to have pathological gastroesophageal reflux and to have more acid symptoms than patients with a small hiatus hernia. However, it is unlikely that patients with an absence of acid symptoms will have pathological reflux regardless of hernia size.

Keywords: Heartburn, Hiatus hernia; Acid reflux

Core tip: Patients with a large hiatus hernia assessed by high resolution esophageal manometry are more prone to have pathological gastroesophageal reflux and to have more acid symptoms than patients with a small hiatus hernia. However, it is unlikely that patients with an absence of acid symptoms will have pathological reflux regardless of hernia size.