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Comprehensive Assessment of Esophageal Disorders Associated with Hiatus Hernia: Insights from Big Data Analysis

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Abstract

Hiatus hernia (HH) is a prevalent endoscopic finding in clinical practice, frequently co-occurring with esophageal disorders, yet the prevalence and degree of association remain uncertain. We aim to investigate HH’s frequency and its suspected association with esophageal disorders. We reviewed endoscopic reports of over 75,000 consecutive patients who underwent gastroscopy over 12 years in two referral centers. HH was endoscopically diagnosed. We derived data on clinical presentation and a comprehensive assessment of benign and malignant esophageal pathologies. We performed multiple regression models to identify esophageal sequela associated with HH. The overall frequency of HH was (16.8%); the majority (89.5%) had small HHs (<3 cm). Female predominance was documented in HH patients, who were significantly older than controls (61.1±16.5 vs. 52.7±20.0; P < 0.001). The outcome analysis of esophageal pathology revealed an independent association between HH, regardless of its size, and erosive reflux esophagitis (25.7% vs. 6.2%; OR = 3.8; P < 0.001) and Barrett’s esophagus (3.8% vs. 0.7%; OR = 4.7, P < 0.001). Furthermore, following rigorous age and sex matching, in conjunction with additional multivariable analyses, large HHs were associated with higher rates of benign esophageal strictures (3.6% vs. 0.3%; P < 0.001), Mallory Weiss syndrome (3.6% vs. 2.1%; P = 0.01), and incidents of food impactions (0.9% vs. 0.2%; P = 0.014). In contrast, a lower rate of achalasia was noted among this cohort (0.55% vs. 0%; P = 0.046). Besides reflux-related esophageal disorders, we outlined an association with multiple benign esophageal disorders, particularly in patients with large HHs.

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Data Availability

The data supporting this study’s findings are available on request from the corresponding author.

Abbreviations

HH:

Hiatal hernia

GERD:

Gastroesophageal reflux disease

GI:

Gastrointestinal

UGIB:

Upper gastrointestinal bleeding

NERD:

Non-erosive reflux disease

PPI:

Proton pump inhibitor

MWS:

Mallory Weiss syndrome

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Funding

This research received no external funding. All authors have read and agreed to the published version of the manuscript.

Author information

Authors and Affiliations

  1. Department of Gastroenterology and Hepatology, Hillel Yaffe Medical Center, Hadera, Israel

    Fadi Abu Baker, Randa Taher Natour & Yael Kopelman

  2. Division of Gastroenterology, Department of Surgical, Oncological and Gastroenterological Sciences, University of Padua, Padua, Italy

    Edoardo Savarino

  3. Department of Gastroenterology, Azrieli Faculty of Medicine, Nazareth EMMS Hospital, Bar Ilan University, Safed, Israel

    Helal Said Ahmad & Amir Mari

  4. Department of Radiology, Hillel Yaffe Medical Center, Hadera, Israel

    Abdel-Rauf Zeina

  5. Department of Surgery, Nazareth Hospital, EMMS, Nazareth, Faculty of Medicine, Bar-Ilan University, Ramat Gan, Israel

    Wisam Abboud

  6. Department of Gastroenterology, Faculty of Medicine in the Galilee, Galilee Medical Center, Bar-Ilan University, Nahariya, Safed, Israel

    Tawfik Khoury

  7. Department of Internal Medicine, Hillel Yaffe Medical Center, Hadera, Israel

    Randa Taher Natour

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  1. Fadi Abu Baker
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Correspondence to Randa Taher Natour.

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This study was performed in accordance with the Helsinki Declaration and Rules of Good Clinical Practice, protocol code HYMC-0071-21.

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Baker, F.A., Savarino, E., Ahmad, H.S. et al. Comprehensive Assessment of Esophageal Disorders Associated with Hiatus Hernia: Insights from Big Data Analysis. Dysphagia 39, 623–631 (2024). https://doi.org/10.1007/s00455-023-10642-6

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