A study on acid reflux in children with hiatal hernia

Abstract

Objective To investigate the acid reflux in children with hiatal hernia (HH) and the characteristic of reflux among different types of HH. Methods Ambulatory 24 h lower esophageal pH monitoring was studied in 35 patients with HH confirmed by barium swallow, of whom 18 cases had sliding hernia, 8 had paraoesophageal hernia, 9 had mixed hernia, and 16 healthy infants formed the control groups. Results All parameters in HH patients were significantly higher than those in controls (P < 0.01) . Thirty-three of 35 patients (accounting for 94%) had pathological acid reflux according to Boix-Ochoa criterion, while the other 2 cases were considered to have physiological reflux, diagnosed as paraoesophageal hernia and mixed hernia, respectively. In HH patients, the number of reflux episodes lasting for 5 min, the duration of the longest episode, mean duration of reflux episodes and the percentage of time of pH < 4 for total periods were significantly higher at lying than at standing position ( P < 0.05) . No significant differences in all parameters except for the duration of the longest episode were found in the patients among three kinds of hernia. Conclusions These results showed that pathological acid reflux almost always existed in children with HH, especially at lying position. The association between the severe degree of acid reflux and the type of HH was not obvious. The study revealed that it is important to treat the HH patients with antireflux therapy early and effectively regardless its types. Key words: Hernia, hiatal; Hydrogen-ion concentration; Gastroesophageal reflux