Do Hiatal Hernias Influence GERD in Patients on PPI Therapy?

Abstract

Introduction: 24-hour Multichannel intraluminal impedance and pH (MII-pH) esophageal monitoring allows detection of Gastro-esophageal reflux (GER). MII-PH allows identification of acid and non-acid reflux. Hiatal hernia (HH) is more common in Western countries. Complications of HH are frequent and are usually related to reflux. Aim: To evaluate the effect of the presence and size of HH on the GER characteristics assessed by MIIpH. Methods: Retrospective review of 119 consecutive adult patients on proton pump inhibitor (PPI) therapy who underwent an upper endoscopy and MII-pH studies (81 Females, mean age =52 years) between 2009 and 2014. Presence and size of HH was identified endoscopically. The group was divided based on the presence of HH and then subdivided based on the size of HH: small HH =2-3cm, medium HH=4-5cm and large HH ≥6cm. MII-pH reports were reviewed to assess GER characteristics. Results: 63/119 (52%) patients had HH. There was no statistically significant difference between the presence and size of HH and GER characteristics (tables). Conclusion: In patients on PPI therapy, HH does not seem to increase GERD as measured by MII-pH.Table 1: HH vs. no HHTable 2: Size of HH vs. no HH