Hiatal hernia size predicts abnormal pH testing: a retrospective cohort study

Area of Science:

• Gastroenterology
• Surgical Research
• Diagnostic Imaging

Background:

• Hiatal hernia (HH) impairs the anti-reflux barrier, contributing to gastroesophageal reflux disease (GERD).
• Objective GERD assessment relies on ambulatory 96-hour wireless pH monitoring.
• The correlation between hiatal hernia size and abnormal pH testing outcomes is not well-defined.

Purpose of the Study:

• To investigate the association between hiatal hernia size and positive pH study results.
• To evaluate hiatal hernia size as a predictor of abnormal gastroesophageal reflux disease (GERD).

Main Methods:

• Retrospective analysis of 363 patients with hiatal hernias undergoing preoperative pH monitoring.
• Abnormal pH study defined by Lyon Consensus criteria (acid exposure time ≥ 6%).
• Multivariable logistic regression analyzed predictors of abnormal pH testing, with hiatal hernia size stratified into categories.

Main Results:

• 79.3% of patients exhibited abnormal pH testing.
• Abnormal pH prevalence increased with hiatal hernia size up to 5.0-5.9 cm (95.2%), then decreased for hernias ≥ 6.0 cm (68.4%).
• Hiatal hernia size (2.0-5.9 cm) was an independent predictor of abnormal pH testing, with higher odds ratios for larger hernias. Larger hernias also correlated with higher acid exposure time, DeMeester scores, and esophagitis severity.

Conclusions:

• Intermediate-to-large hiatal hernias (2.0-5.9 cm) are significant anatomical predictors of abnormal reflux.
• Hiatal hernia size can inform preoperative evaluations for patients with suspected GERD.