Prevalence of Hiatus Hernia in Patients with Gastro Esophageal Reflux Disease Attending Endoscopy Unit

Abstract

Background: A hiatal hernia occurs when a portion of the stomach prolapses through the diaphragmatic esophageal hiatus. Although the existence of hiatal hernia has been described in earlier medical literature, it has come under scrutiny only in the last century or so because of its association with gastro esophageal reflux disease (GERD) and its complications. The aims of this study are to determine the prevalence of hiatus hernia in patients with GERD attending endoscopy unit at Al Sadr Teaching Hospital in Basra city, Iraq, and the role of Helicobacter pylori infection in the development of hiatus hernia.
Methods: A cross-sectional study included 150 patients with GERD attending the endoscopy unit in Al-Sadr Teaching Hospital in Basra city for 6 months period from April 2024 to October 2024 Only patients with GERD enrolled in the study. Patients with high and intermediate likelihood of GERD were admitted to the endoscopy unit and esophageal gastro duodenoscopies were obtained for them. Patients who have hiatus hernia were reported and their relationship with demographic distribution, smoking, obesity, diet, drugs, co-morbidities and presence of H. pylori infection.
Result: The mean age was 40.45 ± 12.25 years, with an average BMI of 27.61 ± 5.61 kg/m. The mean fasting blood glucose was 5.97 ±1.5 mmol/L. Among 150 patients enrolled in the study, 77 (51.3%) were men, 54 (36%) were current smokers, and 52 (34.7%) were hypertensive. The presenting symptoms were as follows: 91 (60.7%) dyspepsia, 50 (33.3%) epigastric pain, S (3.3%) chest pain, and 4 (2.7%) palpitation. Only 31 (20.7%) patients showed positive serological results to H. pylori, while a hiatus hernia was found by endoscopy in 25 (16.7%) of them. When patients with hiatus hernia on oesophago gastro duodenoscopy (OGD) were
compared with those without this abnormality, the mean age in the first group was 37 ± 10 years, compared to 41 ≤ 13 years in the second. The mean blood pressure
was 13516 / 81 ± 9 mmHg versus 131 ± 17 / 80 1 0 mmHg in the two groups, respectively. The mean BMI was 31.64 ± 6.88 kg/m and 26.81 ± 4.97 kg/m in patients with and without hiatus hernia, respectively (p = 0.014).
Conclusion: Hiatus hernia is found in about one sixth of patients presenting to the outpatient endoscopy units in Basra and dyspepsia is the most common presentation among them and is strongly correlated with obesity and thus weight reduction is recommended in symptomatic patients with this abnormality.