Factors associated with hiatal hernia in neurologically impaired children

Abstract

Hiatal hernia (HH) is the axial displacement of the proximal stomach through the diaphragmatic hiatus of the diaphragm. 1 The distal esophagus is anchored to the esophageal hiatus by the phrenoesophageal membrane. 2 Repeated stress of swallowing, abdominal straining, vomiting, and gastroesophageal reflux (GER) reduce phrenoesophageal membrane elasticity, leading to HH. [3][4][5] Because HH is caused by repetitive stress over many years, HH is usually common in older adults and relatively less common in children. However, in children with chronic conditions such as neurological problems or a history of specific surgery or chemotherapy in the past, HH may occur even in early childhood. 6 HH is clinically important because it impairs the protective mechanism that prevents GER-induced injury, and a clear association between HH and gastroesophageal reflux disease (GERD) has also been confirmed in studies in children and adults. [7][8][9][10][11] Because HH weakens the protective mechanism of GER, children with HH develop more severe GER than they would otherwise. HH-induced GER often worsens despite antireflux medications or lifestyle