Incidence Of Hiatal Hernia Research Articles

Evaluation of the frequency of hiatal hernia in patients undergoing upper gastrointestinal system endoscopy

Obesity was identified as an essential and independent risk factor for hiatal hernia. This study focused on the frequency of hiatal hernia detection in patients who underwent upper gastrointestinal system endoscopy in our clinic. The relationship between the frequency of hiatal hernia and demographic data and the patient's height-weight-body mass index was evaluated. This study examined the frequency of Hiatal hernia detection in 303 patients who underwent upper gastrointestinal endoscopy at our institution. The relationship between the frequency of hiatal hernia and demographic data and the patient's height-weight-body mass index was evaluated. Patient data were obtained from the hospital's electronic database. Age, gender, and upper gastrointestinal endoscopy reports were examined. The frequency of Hiatal hernia detection in patients who underwent upper gastrointestinal endoscopy was documented. According to the distribution of demographic and clinical findings of the patients, there was a statistically significant difference between the groups in terms of gender, age, waist circumference, and the occurrence of esophagitis (p<0.05). The incidence of hiatal hernia was higher in men than in women, and the ages of patients with hernia were higher than those without. Waist circumferences and esophagitis rates of patients with hiatal hernias were higher than those without. As a result, obesity and body mass index (BMI) carry risks for hiatus hernia. In obese patients, Hiatal hernia should be included in the differential diagnosis of gastrointestinal complaints. The gold standard in the diagnosis of reflux is clinical and endoscopic examination.

Incidence of hiatus hernia among semi-urban population with upper gastrointestinal symptoms: a single cantered study

Background: Hiatal hernias are a common occurrence in the western population, with an estimated prevalence of 15% to 20%. These hernias may become symptomatic and lead to gastroesophageal reflux disease (GERD), dysphagia, dyspnoea, and may affect cardiac and respiratory function. Being overweight and elderly are the key risk factors in its development.Other known risk factors include: multiple pregnancies, history of oesophageal surgery, partial or full gastrectomy and certain disorders of the skeletal system associated with bone decalcification and degeneration.Methods: This is a retrospective study done on patients who presented to the surgical outpatient at Trichy SRM Medical College Hospital and Research Centre during the period July 2021 to July 2022.Results: Total of 97 (19.02%) patients presented with lax hiatus 41 (42.27%) and had it exclusively while 5 (5.16%), 31 (31.96%), 10 (10.31%) and 10 (10.31%) had it associated with antral gastritis, diffuse gastritis, pan gastritis and oesophagitis respectively. These values were statistically significant with a p value <0.001. And lax hiatus was more commonly seen among female 56 (57.73%) compared to male 41 (42.27%) and hiatus hernia observed more in male 21 (58.33%) than female 15 (41.67%), there was no statistical significance observed among both the gender.Conclusions: Among the patients those who have presented to the surgery outpatient at Trichy SRM with upper gastrointestinal symptoms and in whom upper GI endoscopy were done the incidence of hiatus hernia was observed to be more prevalent among men compared to women in whom lax hiatus were seen to exist.

Study on incidence of hiatus hernia in patients undergoing upper gastrointestinal endoscopy for upper gastrointestinal symptoms in a secondary care hospital

Background: Hiatus hernia refers to condition in which elements of the abdominal cavity, most commonly the stomach, herniate through the oesophageal hiatus into the mediastinum.Hiatal hernia is a frequent finding during upper gastrointestinal endoscopy. Type I hiatal hernia is the sliding hiatal hernia, which accounts for more than 95% of all hiatal hernias with the remaining 5% being paraesophageal hiatal hernias taken together. Surgical therapy is recommended for patients with severe and refractory GERD symptoms such as poor compliance to long-term medical therapy and young patients wishing to avoid lifetime medical treatment. The objective of this study was to identify the associated symptoms and to determine diagnostic accuracy of endoscopic evaluation in patients with hiatus hernia.Methods: Current retrospective study comprised of 250 patients who presented with complaints of upper gastrointestinal symptoms and underwent upper gastrointestinal endoscopy in JSS hospital, Chamarajnagar during the period of October 2018 to May 2020.Results: Out of 250 patients, 162 males (64.8%) and 88 females (35.2%) were part of the study, who presented with upper GI symptoms, 12 (4.8%) patients were diagnosed with hiatus hernia. Out of these 12 cases, 9 patients (75%) were found to be having sliding type of hiatus hernia and 3 patients (25%) having rolling type.Conclusions: Early diagnosis and timely management or surgical intervention reduces morbidity associated with hiatus hernia and acid reflux. Hence, all patients presenting with persistent upper gastrointestinal symptoms should undergo upper GI endoscopy managed accordingly.

Clinical features and therapeutic responses to proton pump inhibitor in patients with severe reflux esophagitis: A multicenter prospective observational study.

Background and AimIn patients with severe erosive reflux disease (ERD; Los Angeles classification grade C/D) who do not undergo endoscopic examination, insufficient strength and duration of proton pump inhibitor (PPI) therapy may lead to complications such as esophageal bleeding and stenosis. Therefore, to provide a safe and effective treatment for gastroesophageal reflux disease (GERD), we investigated the clinical features of patients with severe ERD and their responses to PPI therapy.MethodsPatients with GERD symptoms received PPI therapy for 4 weeks after endoscopic examination. The patients completed the Gastroesophageal reflux and dyspepsia therapeutic efficacy and satisfaction test questionnaire before and 2 or 4 weeks after PPI treatment. Patient characteristics, presence/absence of coexisting atrophic gastritis (AG) and hiatus hernia (HH), and responses to PPI therapy were compared in patients with GERD among three groups (nonerosive reflux disease, mild ERD [grade A/B], and severe ERD).ResultsThe severe ERD group had a significantly higher proportion of males, higher body mass index, and longer duration of GERD morbidity. Furthermore, the severe ERD group also had a significantly lower incidence of coexisting AG and higher incidence of HH. There was no difference in the severity of GERD before PPI treatment among the three groups. Unexpectedly, the response to PPI therapy was the best in the severe ERD group.ConclusionSufficient strength and period of PPI therapy are required, even if the symptoms show early improvement, when treating GERD patients without performing endoscopy, considering the possibility of severe ERD.

Incidence of de Novo Hiatal Hernia after Laparoscopic Sleeve Gastrectomy.

After laparoscopic sleeve gastrectomy (LSG), several studies have reported an increase in the incidence of gastroesophageal reflux (GERD). The etiopathogenesis of GERD post-LSG is multifactorial, and hiatal hernia (HH) is one of them. The primary objective was to measure the incidence of de novo HH post-LSG. The secondary objectives were to relate the presence of HH with GERD, the chronic use of proton pump inhibitors (PPI), and the time elapsed from LSG. A surgical evaluation of the crura after LSG was performed. A retrospective cohort study of 74 consecutive patients with history of LSG submitted to an intra-abdominal surgery that allowed the evaluation of the crura. Of a total of 74 patients, 51 were included. At the time of surgery, 37 patients (72.5%) had a HH; 24 patients (47.1%) had GERD, and 23 patients (45.1%) were frequently using PPI. When patients with HH and those without HH were compared, GERD was observed in 56.8% versus 21.4% (p= 0.01) and frequent consumption on PPI was found in 54.1% versus 21.4% (p= 0.02). According to the data of LSG, with a follow-up of < 18months, 60% presented HH; meanwhile, with a follow-up of > 18months, 84.6% presented HH (p= 0.02). Patients submitted to LSG showed a high incidence of de novo HH. HH was associated with a higher incidence of GERD and PPI dependence. The longer the time elapsed from the LSG, the greater the incidence of HH.

Transverse colon perforation in the mediastinum after esophagectomy: a case report

BackgroundWhile anastomotic leakage, recurrent laryngeal nerve paralysis, and pneumonia are well-known complications of esophagectomy, the incidence of hiatal hernia after esophagectomy for carcinoma has been reported to only be between 0.6 and 10%. We report a very rare case of hiatal hernia with transverse colon rupture in the mediastinum after esophagectomy in a 65-year-old woman.Case presentationThe patient underwent definitive chemoradiotherapy for clinical stage IIA esophageal squamous cell carcinoma and salvage esophagectomy with gastric tube reconstruction through a posterior mediastinum route for residual carcinoma. Three years after the initial surgery, two metastatic nodules in the lateral and posterior segments of the liver were detected on follow-up CT and were treated with oral anticancer drugs. After 6 months, the patient was readmitted for anorexia. Upon admission, computed tomography revealed an ileus caused by a hiatal hernia. Emergent operative repair was performed; an incarcerated herniation of the transverse colon was perforated in the mediastinum, and partial transverse colon resection and colostomy were performed. Intensive care was required to control septic shock after surgery, and the patient was discharged on the 53rd postoperative day.ConclusionsCases of hiatal hernia with digestive tract prolapsing into the mediastinum after esophagectomy with reconstruction through posterior mediastinum are rare but potentially life-threatening complications.

Changes in Time in Yield of Upper Gastrointestinal Endoscopy in Relation to the Applicants Speciality

Introduction: The diagnostic yield of upper gastrointestinal endoscopy (UGE) is high. Aim: A study was done in order to relate the outcome of UGE to the speciality of the applicant and to study changes in yield in a long period of time. Material and Methods: A large dataset was used. The endoscopic diagnoses were noted as a percentage of the yearly procedures done on request of the specific applicant. The following endoscopic diagnoses were primarily scored: reflux oesophagitis, peptic ulcer disease, hiatal hernia or insufficient gastric cardia, and cancer. Results: A total of 36650 procedures were studied via the general practitioner (GP) in 14913 cases (40.6%), the gastroenterologist in 6993 (19%), surgeon or cardiologist in 496 (1.4%) and in 14248 cases (38.9%) via the internist. No abnormalities and reflux oesophagitis were significantly more often scored in cases done on request of the GP. Cancer was more often seen in cases with the gastroenterologist as the applicant. After an initial rise incidence of hiatal hernia, insufficient cardia, and reflux oesophagitis, both findings show a decrease since 2007. There is some yearly fluctuation in presence of reflux-oesophagitis and cancer, while peptic ulcer disease decreases. Conclusion: The general yield of UGE is relatively high. There are differences in outcome if the applicant is taken into account. It is also clear that gastro-oesophageal reflux disease is a condition mostly treated by general practitioners.

Hiatal hernia after oesophagectomy: a large European survey.

Hiatal hernias (HH) after oesophagectomy are rare, and their surgical management is not well standardized. Our goal was to report on the management of HH after oesophagectomy in high-volume tertiary European French-speaking centres. We conducted a retrospective multicentre study among 19 European French-speaking departments of upper gastrointestinal and/or thoracic surgery. All patients scheduled or operated on for the repair of an HH after oesophagectomy were collected between 2000 and 2016. Demographics, details of the initial procedure, surgical management and long-term outcome were analysed. Seventy-nine of 6608 (1.2%) patients who had oesophagectomies were included in the study. The postoesophagectomy diagnostic interval of an HH after oesophagectomy was ≤90 days (n = 17; 21%), 13 were emergency cases; between 91 days and 1 year, n = 21 (27%), 13 in emergency; ≥1 year, n = 41 (52%), 17 in emergency. The time to occurrence of HH after oesophagectomy was shorter after laparoscopy (median 308 days; interquartile range 150-693) compared to that after laparotomy (median 562 days, interquartile range 138-1768; P = 0.01). The incidence of HH after oesophagectomy was 0.73% (22/3010) after open surgery and 1.4% (26/1761) after laparoscopy (P = 0.03). Among the 79 patients, 78 were operated on: 35 had laparotomies (45%), 19 had laparoscopies (24%) and 24 (31%) had transthoracic approaches. Among the 43 urgent surgeries, 35 were open (25 laparotomies and 10 transthoracic approaches) and 8 were laparoscopies (conversion rate, 25%). Nine patients required bowel resections. Morbidity occurred in 36 (46%) patients with 1 postoperative death (1.2%). During the follow-up period, recurrent HH after oesophagectomy requiring revisional surgery developed in 8 (6 days-26 months) patients. Surgical management of HH after oesophagectomy could be done by laparoscopy in patients with scheduled surgery but laparotomy or thoracotomy was preferred in urgent situations. The incidence of HH after oesophagectomy is higher and its onset earlier when laparoscopy is used at the initial oesophagectomy.

The incidence of hiatal hernia and technical feasibility of repair during bariatric surgery

To evaluate the incidence and outcomes of hiatal hernias (HH) that are repaired concomitantly during bariatric surgery. We identified patients who had concomitant HH repair during bariatric surgery from 2010 to 2014. Data collected included baseline demographics, perioperative parameters, type of HH repair, and postoperative outcomes. A total of 83 underwent concomitant HH during study period. The male-to-female ratio was 1:8, mean age was 57.2 ± 10.0 years, and mean body mass index was 44.5 ± 7.9 kg/m(2). A total of 61 patients had laparoscopic Roux-en-Y gastric bypass, and 22 had laparoscopic sleeve gastrectomy. HH was diagnosed before bariatric surgery in 32 (39%) subjects, whereas 51 (61%) were diagnosed intraoperatively. Primary hernia repair was performed with anterior reconstruction in 45 (54%) patients, posterior in 21 (25%), and additional mesh placement in 7 (8%). A total of 24 early minor postoperative symptoms were reported. At 12 month follow-up, mean body mass index improved to 30.0 ± 6.2 kg/m(2), and anti-reflux medication was decreased from 84% preoperatively to 52%. Late postoperative complications were observed in 3 patients. A comparative analysis with a matched 1:1 control group displayed no significant differences in operative time (P = .07), duration of stay (P = .9), intraoperative complications, or early (P = .09) and late post-operative symptoms (P = .3). In addition, no differences were noted in terms of weight-loss outcomes. The true incidence of HH may be underestimated before bariatric surgery. Combined repair of HH during bariatric surgery appears safe and feasible.

The Incidence of Hiatal Hernia After Minimally Invasive Esophagectomy

IntroductionMinimally invasive esophagectomy (MIE) has evolved as a means to minimize the morbidity of an operation which is traditionally associated with a significant risk. However, this approach may have its own unique postoperative complications. In this study, we describe the incidence and outcomes of hiatal hernia in a cohort of MIE patients. MethodsClinical follow-up data on 114 patients who had undergone minimally invasive esophagectomy between 2003 and 2011 were retrospectively reviewed. Clinical presentation and computed tomography (CT) scans of the chest and abdomen were used to establish the diagnosis of hiatal herniation after minimally invasive esophagectomy. Age, gender, presenting complaint, comorbid conditions, clinical tumor stage, surgical specimen size, length and cost of hospital admissions, operation performed for hiatal herniation, and mortality were all recorded for analysis. ResultsNine (8 %) of the 114 patients who underwent MIE had postoperative hiatal herniation. Five of these patients were asymptomatic. All patients except two who presented emergently were repaired laparoscopically on an elective basis. The average length of stay after hiatal hernia repair was 5.5 days (range 2–12) at an average charge of $40,785 (range $25,264–$83,953). At follow-up, one patient complained of symptoms associated with reflux. ConclusionHiatal herniation is not a rare event after MIE. It is also associated with significant health-care cost and may be lethal. Most occurrences appear to be asymptomatic and, if detected, can be repaired with good resolution of symptoms, minimal associated morbidity, and no mortality.

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Introduction: INTRO: Incidence of hiatal hernias (HH) increases with age. Approximately 60% of individuals aged 50 or older have a HH. [1] A giant HH is a hernia that includes at least 30% of the stomach in the chest, although a uniform definition does not exist; most commonly, a giant HH is a type III hernia with a sliding and paraesophageal component [2]. Patients with a giant HH generally present with pain, heartburn or a history of heartburn, dysphagia, vomiting, and anemia. We present a case of giant HH presenting with hematemesis. Case: An 83-year-old non-smoking female patient, with breast cancer who underwent breast biopsy and sentinel node dissection 2 days prior, presented to her local hospital with severe lower chest discomfort, nausea and vomiting with episodes of hematemesis. Initial workup with chest x-ray revealed a giant chest abnormality (figure 1). Pulmonary was consulted to evaluate the giant chest mass. Further review of imaging revealed a giant paraesophageal hiatal hernia with most of her stomach residing in the chest. The stomach was massively dilated and appeared volvulized. She had endoscopy at an outside facility and they drained a liter of fluid from her stomach. A nasogastric tube was placed. However, the stomach remained massively dilated and did not appear to be emptying. She was transferred for further care. Upon transfer, the patient was on a 100% nonrebreather due to difficulty breathing. Her pain and nausea had improved; however, she remained dyspneic. She had mild tenderness in the epigastrium and her white count was elevated at 18,000. She was taken to the operating room by cardiothoracic surgery urgently for reduction of her giant paraesophageal hiatal hernia. On the date of discharge, she was satting 93% on room air. Pathology of the hernia sac revealed mesothelial lined fibrous tissue consistent with hernia sac. Discussion: HH is the protrusion of the upper part of the stomach into the thorax through a tear or weakness in the diaphragm. A HH is classified by type as follows: type I indicates sliding hernia; type II, paraesophageal hernia ( 5%); type III, mixed sliding and paraesophageal hernia; and type IV, herniation of additional organs (eg, colon, omentum, spleen). [3] A giant HH is a hernia that includes at least 30% of the stomach in the chest and most commonly is a type III hernia with a sliding and paraesophageal component. This case illustrates the varied presentations of giant HH and the need for early suspicion given the need for surgical intervention. Conclusion: This case illustrates the need to consider giant HH in the presence of hematemesis. Early recognition of this rare entity can lead to early surgical intervention.

Laparoscopic Antireflux Surgery: A Comparative Study of Nissen Fundoplication and Hiatoplasty With and Without Absorbable Biological Mesh

Background: Laparoscopic Nissen fundoplication with hiatoplasty has been shown to be an effective antireflux operation. The use of biological mesh in hiatoplasty has been controversial. Method: This retrospective comparative study included all patients with severe symptomatic gastro-oesophageal reflux disease who underwent antireflux surgery with and without biological mesh repair in one surgeons practice, 202 patients who underwent Nissen fundoplication with hiatus hernia repair between 2000 and 2010 were retrospectively analysed. Patients were divided into 4 groups: large paraoesophageal hernia with Surgisis mesh (n = 24) and without (n = 61); and patients without hiatal hernia with Surgisis mesh (n = 26) and without (n = 91). The Incidence of recurrence of hiatal hernia and post-operative side-effects were the outcome measures. Results: In the group with paraoesophageal hernia at approximately 6 months postoperatively, the side-effects reported by patients without Surgisis mesh were reflux (15%), flatulence (28%), dysphagia (46%), and hiatal hernia recurrence (13%). Comparatively, patients receiving Surgisis mesh repair reported side effects of reflux (8%), flatulence (17%), dysphagia (75%), and hiatal hernia recurrence (4%). In the group without large hernia, the side-effects reported by patients without Surgisis mesh were reflux (12%), flatulence (20%), dysphagia (41%), and incidence of hiatal hernia (1%) and in patients with Surgisis mesh repair the rates of side-effects were: reflux (11%), flatulence (19%), dysphagia (69%), and incidence of hiatal hernia (3.8%). Conclusion: This retrospective analysis shows that antireflux surgery with an absorbable biological mesh hiatoplasty is safe, and may lead to a reduction in the incidence of recurrent hiatal hernia. It also produces good control of reflux, with low risk of side-effects and complications. doi: http://dx.doi.org/10.4021/jcs185w

Thoracic Deformity and Hiatal Hernia (Intrathoracic Stomach) in the Elderly

The incidence of hiatal hernia (HH) increases with age. Vertebral fracture, kyphosis, and pulmonary emphysema are suspected as possible causes. We aimed to analyze the relationship between thoracic deformities and HH in the elderly, using a deformity index. The study participants comprised 427 inpatients at a long-term-care hospital for the elderly in Japan. The Haller index (HI) was calculated on the transverse thoracic computerized tomography images according to the following formula: transverse diameter of the thorax/anterior-posterior diameter of the thorax. HH was diagnosed when an intrathoracic stomach was seen on the computed tomography images. The average HI calculated for all cases and for women--but not for men--decreased with increasing age. HH was diagnosed in 21 patients (4.9%). The incidence of HH in women was higher than in men (male vs. female = 2.0% vs. 7.4%). The mean value of HI in the HH patients (1.651 ± 0.251) was significantly lower than that in non-HH patients (2.345 ± 0.460). Enlargement of the anterior-posterior diameter of the thorax occurs in the elderly and is associated with the occurrence of HH.

Nonerosive gastroesophageal reflux disease and mild degree of esophagitis: Comparison of symptoms endoscopic, manometric and pH-metric patterns

BackgroundOur aim in the present study was to compare patients presenting with gastroesophageal reflux disease in the presence or absence of mild-grade esophagitis (grade I or II according to the Savary-Miller classification).MethodsBetween 2005 and 2007, 215 patients with gastroesophageal reflux disease (67 with reflux associated with grade I or II esophagitis and 148 without esophagitis) were evaluated at the Department of Surgery, University Hospital Tor Vergata, Rome, and were included in the present study. The evaluations consisted of clinical interviews, endoscopy of the high digestive tract, esophageal manometry and pH monitoring.ResultsThere was no significant difference between the two groups with regard to age, sex or symptoms. The incidence of heartburn associated with noncardiac chest pain was greater in the esophagitis group than in the dysphagia group. The incidence of hiatal hernia was similar in both groups. Although the motor pattern was similar in both groups, the length of the abdominal esophagus was greater in patients without esophagitis (1.6 cm vs 1.1 cm; P < 0.05). The reflux pattern was nearly identical in both groups.ConclusionsGastroesophageal reflux without esophagitis must be regarded not as a milder form of the disease but as part of a single disease. Furthermore, these patients often demonstrate lower rates of symptom improvement after antireflux treatment in comparison with patients with erosive esophagitis. Therefore, further trials to assess the treatment algorithm for these patients are warranted.

Mo1479 The Incidence of Hiatal Hernia After Minimally Invasive Esophagectomy

Mo1479 The Incidence of Hiatal Hernia After Minimally Invasive Esophagectomy

Presence of Vertebral Fractures is Highly Associated with Hiatal Hernia and Reflux Esophagitis in Japanese Elderly People

Recent studies have shown the correlation between vertebral fractures (VFs) and gastrointestinal disorders in postmenopausal women. The aim of this study was to assess the association between VFs and hiatal hernia (HH) and/or reflux esophagitis (RE) in our patient population of both men and women. We analyzed retrospective data of 280 patients aged 60 years or older (140 men and 140 women, mean +/- SD 73.5 years +/-7.05) who had undergone upper gastrointestinal endoscopy and chest X-rays in our hospital from August 2005 to February 2006. We analyzed the correlation between the presence of VFs and the presence of HH and/or RE. The incidence of RE in this study was 13.9% (39/280) and that of HH was 30.0% (84/280). Among these patients, 12.1% (41/280) had VFs. The incidence of RE in patients with VFs was 24.4% (10/41) and without VFs was 12.1% (29/239), with the difference being significant between those with and without VFs (p<0.05). The incidence of HH in patients with VFs was 43.9% (18/41) and in those without VFs was 27.6% (66/239), p<0.05. We subdivided subjects into four groups: HH only group, RE only group, HH/RE group and neither condition present group. We compared the incidence of VFs among these groups. VFs were observed in 16.4% (11/67) of the HH only group, 13.6% (3/22) of the RE only group, 41.2% (7/17) of the HH/RE group and 11.5% (20/174) in the neither condition present group. There was a significant difference in the incidence of VFs between the HH/RE group and neither condition present group (p<0.05). The presence of VFs was significantly associated with the presence of either RE or HH. This association became more significant when HH and RE were present together in elderly Japanese people.

The incidence of hiatal hernia, reflux esophagitis and Barrett's esophagus between 2003 and 2005

Introduction: It has been suggested that hiatus hernia (HH) is an important etiological factor for gastro-esophageal reflux disease (GERD).

Clinical implication of hiatal hernia in patients with right isomerism

Despite a reported association between hiatal hernia in patients with heterotaxy syndrome, the clinical significance has remained unclear. Based on large patient cohorts, this study specifically aimed at defining the implication of hiatal hernia in patients with right isomerism. From 1994 to 2002, 143 patients were identified as having right isomerism. Among them, 119 received ultrafast computed tomography (CT) to determine the presence of hiatal hernia as well as any cardiovascular anomalies. Hiatal hernia was found in 17 patients (seven females and 10 males, 14.3%). The upper gastrointestinal (GI) series in six patients confirmed the diagnosis of hiatal hernia in all and revealed severe gastro-oesophageal reflux in four. The most common symptom of hiatal hernia was vomiting (47%), followed by recurrent bronchiolitis or pneumonia (41.2%) and upper gastrointestinal bleeding (11.8%). Three patients with hiatal hernia underwent fundoplication for medically refractory vomiting. Seven patients were found to have midgut malrotation (5.9%), and four of these had both hiatal hernia and malrotation. Pulmonary atresia was closely associated with the presence of hiatal hernia (p=0.02). One patient with hiatal hernia died suddenly at 6 mo. However, overall mortality was similar between those patients with hiatal hernia and those without. The incidence of hiatal hernia was considerably high in patients with right isomerism, especially in those with pulmonary atresia, and it is this that may have led to vomiting and recurrent airway infections. While an association between sudden death and hiatal hernia may well exist, this does require further clarification.

Gender Differences in Gastroesophageal Reflux Disease: Myth or Reality?

Purpose: Foregut symptoms in women are often thought to be functional or psychological in nature, hence many female patients do not undergo investigation of their upper gastrointestinal symptoms. The aim of this study is to determine if there is a gender difference in the presentation, diagnostic evaluations or response to endoscopic therapy of patients with gastroesophageal reflux disease (GERD). Methods: Patients with typical GERD symptoms referred for endoscopic therapy were evaluated with upper endoscopy, manometry and pH studies. Reflux symptoms were assessed using the following scoring system: Heartburn(HB) Symptom Score (HSS) = HB frequency × HB severity; where HB frequency is: 0=none, 1=<3 episodes per wk, 2=3-5 episodes per wk, 3=daily; HB severity is recorded by patient using a 32 point visual analog scale. Regurgitation Frequency Score (RFS): 0=none, 1=<3 episodes per wk, 2=3-5 episodes per wk, 3=daily. Extra-esophageal manifestations were recorded.Endoscopic treatment consisted of intraluminal gastroplications at the gastroesophageal junction. Results: Ninety-five patients (37 M, 58 F) with the following baseline profile were studied (males vs. females): mean age of 47 ± 17 years vs. 50 ± 13 years, BMI 29 ± 6 vs. 28 ± 5, HSS of 45 ± 31 vs. 46 ± 24, and RFS of 1.7 ± 1.1 vs. 1.8 ± 1.1. The prevalence of extra-esophageal symptoms was similar in men and women: chest pain in 25% vs. 22%, wheezing in 5% vs. 15%, cough in 19% vs. 22%, and reflux laryngitis in 13% vs. 27%. Males had significantly more erosive esophagitis: 38% vs. 13% (p=0.05). The incidence of hiatal hernias and Barrett's esophagus were comparable (males vs. females): 30% vs. 48% (p=0.3) and 13% vs. 5% (p=0.2) respectively. Manometric and pH studies failed to reveal any gender differences (males vs. females): lower esophageal sphincter pressures were 16 ± 8 mmHg vs.13 ± 5 mmHg and total percentage time pH less than 4.0 was 15 ± 13% vs. 18 ± 17%. The response to endoscopic therapy was also similar between genders (males vs. females): complete response 27% vs. 39%, partial response 38% vs. 44%, and no response 22% vs. 17%. Conclusions: The prevalence of typical and extra-esophageal GERD symptoms, and the clinical response to endoscopic therapy are the same for men and women. Male and female patients with GERD have very similar manometric and ambulatory pH study findings. The only gender difference we found was a higher incidence of erosive esophagitis in men. Patients with gastroesophageal reflux symptoms should be evaluated and treated the same regardless of their gender.

Incidence of hiatus hernia and its effect on the treatment of patients with erosive esophagitis

Incidence of hiatus hernia and its effect on the treatment of patients with erosive esophagitis