Association of Subtle Bowel-Like/Fluid-Like Sounds on Chest Auscultation with Advanced Hiatal Hernia

Hiatal hernia is a common condition associated with gastroesophageal reflux disease, yet no reliable physical examination findings have been established. This study investigated the association of subtle bowel-like/fluid-like sounds detected during chest auscultation with the presence and severity of hiatal hernia (HH).

This retrospective observational study analyzed prospectively recorded auscultatory findings in patients undergoing routine examinations at a general outpatient clinic between 2011 and 2024. Patients with and without chest bowel-like sounds (CBS) were compared. Hiatal hernia presence and severity were determined retrospectively by reviewing endoscopy, barium esophagography, or computed tomography findings in medical records and classified into five grades (HH0-HH4). Diagnostic performance indices of CBS and their associations with hernia severity were also analyzed.

Among 117 patients with CBS, 72 had a hiatal hernia, as compared with 170 of 879 patients without CBS. CBS showed low sensitivity (29.8%) but high specificity (94.0%), with a positive predictive value of 61.5%, a positive likelihood ratio of 5.0, and an odds ratio (OR) of 6.7 (95% confidence interval [CI], 4.4-10.0; p < 0.001). The association between CBS and hiatal hernia was stronger in women than in men (OR 13.7 vs. 4.9; interaction p = 0.031). CBS prevalence increased from 6.0% in HH0 to 75.0% in HH4 (p for trend < 0.001). When advanced hiatal hernia (HH3-HH4) was compared with HH0-HH2, CBS yielded substantially better diagnostic performance, with a sensitivity of 64.3%, specificity of 90.6%, LR+ of 6.8, LR- of 0.4, and OR of 17.3 (95% CI, 8.8-33.8; p < 0.001), regardless of sex.

Subtle bowel-like/fluid-like sounds on chest auscultation are highly specific for hiatal hernia and increase with disease severity, suggesting that CBS is particularly useful as a clinical indicator of advanced hiatal hernia in primary care.