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Is herniosis the single etiology of Saint’s triad?

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Sixty years ago, Saint’s triad (hiatus hernia, diverticulosis of the colon, and gallbladder disease) was first described in three patients. Since then, the association of these conditions has been questioned. We tested the hypothesis that these conditions are associated, and, based on recent research, propose a common etiology.


Data from the U.S. Veterans Integrated Service Network (VISN) 16 Data Warehouse were analyzed. Chi-square tests and calculated odds ratios (ORs) were utilized to describe the magnitude of association, and multivariable logistic regression models were used to determine the variables associated with Saint’s triad.


Among 637,518 patient records (1996–2005), any hernia was diagnosed among 22,181 (3.5%) patients, hiatus hernia among 1,661 (0.3%), diverticulosis of the colon among 14,375 (2.3%), and gallbladder disease among 5,284 (0.8%). The following associations were observed: diverticulosis, hiatus hernia (OR: 6.9), hiatus hernia, gallbladder disease (OR = 3.8), and gallbladder disease, diverticulosis (OR = 5.9). Patients with both diverticulosis and gallbladder disease were more likely to have hiatus hernia (OR = 3.8; P = 0.0012) or any hernia (OR = 10.7; P < 0.0001). Diseases associated with Saint’s triad (incorporating any hernia) included chronic obstructive pulmonary disease (OR = 4.3), hypertension (OR = 3.1), aortic aneurysm (OR = 2.2), and diabetes (OR = 1.8).


Herniosis, the systemic connective tissue disease known to cause diverticulosis and herniae, may be responsible for Saint’s triad. Diabetes, like aging, enhanced herniosis. Further research on the gallbladder wall pathology in patients with cholelithiasis or cholecystitis is needed.

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We appreciate the efforts of Mr. Charlton Fort, who accessed the data from the Veterans Integrated Service Network (VISN) 16 Data Warehouse, thus, enabling these analyses.

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Correspondence to R. C. Read.

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M. Hauer-Jensen contributed to the study design, interpretation of results, and manuscript preparation. Z. Bursac cleaned, recoded, and analyzed the data. He wrote the statistical analysis and part of the results section. R.C. Read conceived the study. He wrote the introduction and discussion sections of the manuscript, and he compiled the reference list. All authors contributed to the critical review and revision of the manuscript. All authors have seen and approved the final version of the manuscript.

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Hauer-Jensen, M., Bursac, Z. & Read, R.C. Is herniosis the single etiology of Saint’s triad?. Hernia 13, 29–34 (2009).

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