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Role of hiatal hernia in delaying acid clearance
R J Stewart1, B T Johnston, V E Boston
1Royal Belfast Hospital for Sick Children, Department of Paediatric Surgery.
Insights
Hiatal hernias in children with gastro-oesophageal reflux increase acid clearance time. This finding suggests hiatal hernias worsen reflux symptoms and oesophagitis incidence.
Area of Science:
- Pediatric Gastroenterology
- Gastrointestinal Motility Disorders
Background:
- Gastro-oesophageal reflux (GER) is common in children.
- The role of hiatal hernia (HH) in exacerbating GER symptoms requires further elucidation.
Purpose of the Study:
- To prospectively evaluate the association between hiatal hernia and gastro-oesophageal reflux in pediatric patients.
- To determine if hiatal hernia impacts acid exposure and oesophagitis in children with GER.
Main Methods:
- Prospective study of 95 children with radiologically confirmed GER.
- Investigated patients using 18-hour esophageal pH monitoring and endoscopy.
- Patients categorized into groups with (n=37) and without (n=58) hiatal hernia based on radiology.
Main Results:
- No significant difference in the total number of reflux episodes between groups.
- Children with hiatal hernias had a significantly longer median duration of the longest reflux episode (30 min vs. 19 min).
- A higher number of prolonged reflux episodes (>5 minutes) was observed in the hiatal hernia group; correlation with oesophagitis was noted.
Conclusions:
- Hiatal hernia presence in children with GER is associated with delayed esophageal acid clearance.
- Hiatal hernias contribute to increased acid exposure duration and are linked to a higher incidence of oesophagitis.
Abstract:
The aim of this study was to assess prospectively the relationship of a hiatal hernia to gastro-oesophageal reflux. Ninety five children with symptoms of gastro-oesophageal reflux in whom reflux was demonstrated radiologically were investigated. Oesophageal pH monitoring for 18 hours and endoscopy were performed in all patients. On the basis of radiology, patients were divided into those with hiatal hernia (n = 37) and those without (n = 58). Both groups had the same number of reflux episodes on pH monitoring. However, the median duration of the longest episode was significantly greater in the hiatal hernia group (30 min v 19 min), as was the number of reflux episodes longer than five minutes (5 v 4). The percentage with a pH < 4 just failed to be significantly different (13% v 8%). Hiatal hernia was also found to correlate with the presence of oesophagitis. The presence of a hiatal hernia delays the clearance of acid from the oesophagus and is associated with an increased incidence of oesophagitis.