Hiatus hernia in the adult

Summary and conclusions

A study was made of the clinical manifestations displayed by 214 adult patients with the direct or “sliding” type of hiatus hernia, with the hope of finding subjective illness patterns which would help preclude complete reliance on the necessarily hit-or-miss practice of diagnosis by “routine” upper gastrointestinal x-ray study. The effort was a notable failure. In a negative sort of way, however, it emphasized the varied symptomatology of hiatus hernia and its complications. In particular, it was noted that:

1. Of the 214 patients, 17 had no complaints and the symptoms of only 124 of the others could be ascribed to hiatus hernia or its complications. In the rest a great many associated diseases were found responsible for the symptoms. Saint's triad proved of special significance.

2. In at least one-quarter of the patients with hiatus hernia symptoms, the symptoms were due to the complications of hiatus hernia rather than to the lesion itself.

3. The patients whose symptoms were believed due to hiatus hernia or its complications presented 17 distinct symptom patterns. Fourteen per cent of the patients experienced the sudden onset of acute symptoms. Many familiar gastrointestinal symptom patterns not ordinarily thought of in connection with hiatus hernia were encountered among the rest.

4. The symptom complex usually considered as classical for hiatus hernia (distress brought on or aggravated by recumbency) was observed in only 13 per cent of the whole group and in only 22 per cent of the patients whose symptoms were ascribed to hiatus hernia.