Association between Increased Gastric Juice Acidity and Sliding Hiatal Hernia Development in Humans

Abstract

ObjectivesSeveral clinical factors; overweight, male gender and increasing age, have been implicated as the etiology of hiatal hernia. Esophageal shortening due to acid perfusion in the lower esophagus has been suggested as the etiological mechanism. However, little is known about the correlation between gastric acidity and sliding hiatus hernia formation. This study examined whether increased gastric acid secretion is associated with an endoscopic diagnosis of hiatal hernia.MethodsA total of 286 consecutive asymptomatic patients (64 were diagnosed as having a hiatal hernia) who underwent upper gastrointestinal endoscopy were studied. Clinical findings including fasting gastric juice pH as an indicator of acid secretion, age, sex, body mass index, and Helicobacter pylori infection status determined by both Helicobacter pylori serology and pepsinogen status, were evaluated to identify predictors in subjects with hiatal hernia.ResultsMale gender, obesity with a body mass index >25, and fasting gastric juice pH were significantly different between subjects with and without hiatal hernia. The cut-off point of fasting gastric juice pH determined by receiver operating curve analysis was 2.1. Multivariate regression analyses using these variables, and age, which is known to be associated with hiatal hernia, revealed that increased gastric acid secretion with fasting gastric juice pH <2.1 (OR = 2.60, 95% CI: 1.38–4.90) was independently associated with hiatal hernia. Moreover, previously reported risk factors including male gender (OR = 2.32, 95% CI: 1.23–4.35), body mass index >25 (OR = 3.49, 95% CI: 1.77–6.91) and age >65 years (OR = 1.86, 95% CI: 1.00–3.45), were also significantly associated with hiatal hernia.ConclusionsThis study suggests that increased gastric acid secretion independently induces the development of hiatal hernia in humans. These results are in accordance with the previously reported hypothesis that high gastric acid itself induces hiatal hernia development.

Associations among Gastric Juice pH, Atrophic Gastritis, Intestinal Metaplasia andHelicobacter pyloriInfection

“…Collected gastric juice was categorized into two groups by acid level of pH 3, since previous studies observed below pH 3 as normal gastric acidity range. 3 , 25 In this study, we found that H. pylori infection was significantly associated with gastric acidity. In other words, pH <3 group showed 21.4% of H. pylori infection rate, but pH ≥3 group showed much higher infection rate (61.1%, p=0.007).…”

Increasing rate of para‐oesophageal hiatus hernia surgical repair within Australia

“…19 Interestingly, females were more likely to undergo this operation than males, consistent with the previous series by Bjelovic et al 27 However, the literature concerning risk factors for PEH hernias cites male gender as a risk factor for developing a PEH. 5,6 Reasons for this outcome are not readily apparent, but may include: females are more likely to be diagnosed than males; that the incidence of PEH is unrelated to the need for PEH surgical intervention; or there is interventional bias.…”

“…[2][3][4] Increasing age (>50 years) and being overweight (body mass index >25 kg/m 2 ) are the most common risk factors for HH formation. [5][6][7][8][9] A study conducted in 2013 by Che et al found that 40% of the morbidly obese patients had a HH, 10 while subsequent studies have shown that HH prevalence is associated with obesity prevalence and increasing age. [5][6][7][8][9] A study conducted in 2013 by Che et al found that 40% of the morbidly obese patients had a HH, 10 while subsequent studies have shown that HH prevalence is associated with obesity prevalence and increasing age.…”

“…5 Other risk factors include familial, male gender and an imbalance of type 1 and type 2 collagen at the hiatal orifice. [5][6][7][8][9] A study conducted in 2013 by Che et al found that 40% of the morbidly obese patients had a HH, 10 while subsequent studies have shown that HH prevalence is associated with obesity prevalence and increasing age. 3,5,[11][12][13] Although PEH can be asymptomatic, the risk of progression to becoming symptomatic is about 14% per year.…”

Correction: Association between Increased Gastric Juice Acidity and Sliding Hiatal Hernia Development in Humans

“…Kishikawa H, Kimura K, Ito A, Arahata K, Takarabe S, Kaida S, et al (2017) Correction: Association between Increased Gastric Juice Acidity and Sliding Hiatal Hernia Development in Humans. PLoS ONE 12(2): e0172375.…”