Hiatal hernia, reflux-oesophagitis, and Barrett’s oesophagus A retrospective endoscopic and clinical study

Abstract

A retrospective study amongst 2000 consecutive patients undergoing upper gastrointestinal endoscopy was done for the detection of hiatal hernia, oesophagitis, Barrett’s oesophagus (columnar-lined epithelium) and gastro-esophageal reflux symptoms (GERS). Oesophageal pathology was seen in 476 (23.8%) patients. In 166 (34.8%) patients a hiatal hernia, in 204 (42.8%) a hiatal hernia and oesophagitis, in 79 (16.6%) oesophagitis and in 27 (5.8%) Barrett’s oesophagus was diagnosed. Patients with Barrett’s oesophagus were significantly older than patients with hiatal hernia and/or oesophagitis. 152 (74.5%) patients presenting with hiatal hernia and oesophagitis had gastro-esophageal reflux symptoms and 56 (70.8%) of oesophagitis patients had gastro-esophageal reflux symptoms (p = ns). Of patients with a hiatal hernia, 62% suffered from gastroesophageal reflux symptoms. Only 28.5% of patients with Barrett’s oesophagus without other abnormalities had gastro-esophageal reflux symptoms, in compansion to 70% of Barrrett patients with hiatal hernia and/or oesophagitis who had gastro-esophageal reflux symptoms. Prevalence of gastro-esophageal reflux symptoms decreased with increasing severity of oesophagitis. The more severe cases of oesophagitis were almost invariably seen in patients with concomitant hiatal hernia. It is concluded that a hiatal hernia is a major contributor to oesophagitis.