A 20-year prospective follow-up of childhood hiatal hernia

Abstract

A long-term prospective follow-up of 113 children with vomiting due to a small hiatal hernia is described. When reviewed by the same clinical and radiological observers 20 or more years later, over 90% of unoperated non-stricture patients were asymptomatic whereas only 44% of the stricture and/or surgically treated group were without symptoms. Half or possibly more of the asymptomatic patients still had a hernia and it is possible that these may suffer a recurrence of symptoms later in adult life. The loculus of thoracic stomach tended to retain the same shape; there was a slightly better prognosis for the locular type of hernia compared with the tubular type. Complicating oesophageal strictures can decrease or disappear without surgery other than dilatation; the results of treatment by radical surgery were disappointing. There is need for an even more prolonged follow-up into later adult life.

Familial hiatal hernia in a large five generation family confirming true autosomal dominant inheritance

“…Thirdly, there is very limited examination of other family members. Since an hiatal hernia can be symptomatically silent,13 14 symptom free as well as clinically affected members should be investigated when undertaking detailed family studies.…”

“…Long term follow up studies13 14 have shown that an infantile hiatal hernia will persist into adult life in about half the patients. However, its persistence was not associated with increased symptoms as adults or increased antacid use compared with those with no demonstrable hiatal hernia.…”

Hiatus/paraesophageal hernias in neonatal Marfan syndrome

“…Paraesophageal hernia is defined as herniation of part of stomach superiorly through the diaphragm to lie adjacent to the lower esophagus [Astley, 1977]. However, hiatus hernia is defined as a part of the stomach that ''slides'' above the GEJ as was present in this case.…”

On the pathogenesis of gastroesophageal reflux: The concept of gastroesophageal dyssynergia

“…10 Their opinion that the antireflux barrier is congenitally underdeveloped derived support from the fact that in many adults hiatus hernia could be traced back to their childhood. 10,16,17 Another theory proposed that the antireflux barrier in children and adults is gradually weakened as a result of years of straining at defecation or from other causes. 10 Other investigators postulated a hypothesis on the basis of the progressive anatomic dilatation of the gastroesophageal junction or cardia.…”