Short Segment Hiatal Hernia: Is It a Clinically Significant Entity?

Abstract

Background: It is a well accepted idea that hiatal hernia (HH) has a very important contributory role for the development of GERD. However, the clinical significance of small simple sliding HH has been less well studied and still is not clear. Many patients with small HH¡¯s are believed to be asymptomatic and clinically insignificant. Aim: This study was done to clarify the clinical significance of short segment (i.e. shorter than 2.0 cm in length) HH (SSHH), especially in relation to clinically significant GERD. Methods: Consecutive 4592 cases (M:F 2076:2516, median age 49 years with interquartile range 39~60 years) who underwent their initial routine diagnostic UGI endoscopy at our hospital from various indications were included. Presence and length of sliding HH were determined in each case during insertion of the endoscope while in quiet breathing without retching. Age, gender, presence of erosive esophagitis (EE), and presence of endoscopic columnar-lined esophagus (CLE) were analyzed according to the observed lengths of HH. Among them, 219 cases underwent ambulatory esophageal pH monitoring, and the results were also analyzed. Results: Among 4592 cases, 4164 cases (90.7%) had no HH, 255 cases (5.6%) had SSHH, and 173 cases (3.8%) had long segment HH (LSHH). More males were found in SSHH and LSHH groups than in non-HH group. Ages were older in LSHH group than in other groups. EE was found in 198 cases (4.8%) of non-HH group, 56 cases (22.0%) of SSHH group, and 64 cases (37.0%) of LSHH group (p < 0.001 between groups). CLE was found in 598 cases (14.4%) of non-HH group, 93 cases (36.5%), and 42 cases (24.3%) (p < 0.001 between non-HH group and other groups, p = 0.008 between SSHH and LSHH groups). High Johnson-DeMeester score was significantly less commonly found in non-HH group (26.9%) than in other groups (54.2%, p = 0.006, in SSHH group and 53.8%, p = 0.038, in LSHH group), but no difference was noted between SSHH and LSHH groups. Conclusion: LSHH is not a clinically silent and innocent entity, but it is deserved to be accused as a clinically significant pathologic entity quite similar to LSHH as far as GERD is concerned. Background: It is a well accepted idea that hiatal hernia (HH) has a very important contributory role for the development of GERD. However, the clinical significance of small simple sliding HH has been less well studied and still is not clear. Many patients with small HH¡¯s are believed to be asymptomatic and clinically insignificant. Aim: This study was done to clarify the clinical significance of short segment (i.e. shorter than 2.0 cm in length) HH (SSHH), especially in relation to clinically significant GERD. Methods: Consecutive 4592 cases (M:F 2076:2516, median age 49 years with interquartile range 39~60 years) who underwent their initial routine diagnostic UGI endoscopy at our hospital from various indications were included. Presence and length of sliding HH were determined in each case during insertion of the endoscope while in quiet breathing without retching. Age, gender, presence of erosive esophagitis (EE), and presence of endoscopic columnar-lined esophagus (CLE) were analyzed according to the observed lengths of HH. Among them, 219 cases underwent ambulatory esophageal pH monitoring, and the results were also analyzed. Results: Among 4592 cases, 4164 cases (90.7%) had no HH, 255 cases (5.6%) had SSHH, and 173 cases (3.8%) had long segment HH (LSHH). More males were found in SSHH and LSHH groups than in non-HH group. Ages were older in LSHH group than in other groups. EE was found in 198 cases (4.8%) of non-HH group, 56 cases (22.0%) of SSHH group, and 64 cases (37.0%) of LSHH group (p < 0.001 between groups). CLE was found in 598 cases (14.4%) of non-HH group, 93 cases (36.5%), and 42 cases (24.3%) (p < 0.001 between non-HH group and other groups, p = 0.008 between SSHH and LSHH groups). High Johnson-DeMeester score was significantly less commonly found in non-HH group (26.9%) than in other groups (54.2%, p = 0.006, in SSHH group and 53.8%, p = 0.038, in LSHH group), but no difference was noted between SSHH and LSHH groups. Conclusion: LSHH is not a clinically silent and innocent entity, but it is deserved to be accused as a clinically significant pathologic entity quite similar to LSHH as far as GERD is concerned.