Identifying clinically relevant sliding hiatal hernias: a population-based endoscopy study

Wallner, Bengt; Björ, Ove; Andréasson, Anna; Hellström, Per M.; Forsberg, Anna; Talley, Nick; Agréus, Lars

doi:10.1080/00365521.2018.1458896

Cited by 12 publications

(12 citation statements)

References 17 publications

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“…Histopathological changes are well described in GERD (Figure 3), but the lack of accuracy (specificity 78%, sensitivity 30%) and expense limits their use as a diagnostic tool in GERD [53]. Whilst a hiatal hernia may be identified at endoscopy and may disrupt the high-pressure zone around the lower oesophageal sphincter which forms a tight gastroesophageal flap valve, the assessment in practice is subjective and of limited additional diagnostic help; a hiatal hernia needs to be large to be relevant, at least 2 cm in length [54].…”

Section: Role Of Upper Endoscopy and Biopsymentioning

confidence: 99%

Optimal management of severe symptomatic gastroesophageal reflux disease

Talley

Irani

2020

J. Intern. Med.

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Gastroesophageal reflux disease (GERD) is a common disorder, and empirical proton pump inhibitor (PPI) treatment is often the first step of management; however, up to 40% of patients remain symptomatic despite PPI treatment. Refractory reflux refers to continued symptoms despite an adequate trial of PPI, and management remains challenging. The differential diagnosis is important; other oesophageal (e.g. eosinophilic oesophagitis) and gastroduodenal disorders (e.g. functional dyspepsia) should be ruled out, as this changes management. A combination of clinical assessment, endoscopic evaluation and in selected cases oesophageal function testing can help characterize patients with refractory reflux symptoms into oesophageal phenotypes so appropriate therapy can be more optimally targeted. Medical options then may include adding a H2 receptor antagonist, alginates, baclofen or antidepressant therapy, and there is emerging evidence for bile acid sequestrants and diaphragmatic breathing. The demonstration of a temporal association of symptoms with reflux events on pH‐impedance testing (reflux hypersensitivity) serves to focus the management on modulating oesophageal perception and reducing the reflux burden, or identifies those with no obvious pathophysiologic abnormalities (functional heartburn). Anti‐reflux surgery based on randomized controlled trial evidence has a role in reflux hypersensitivity or continued pathological acid reflux despite PPI in carefully considered, fully worked up cases that have failed medical therapy; approximately two of three cases will respond but there is a small risk of complications. In patients with persistent volume reflux despite medical therapy, given the lack of alternatives, anti‐reflux surgery is a consideration. Promising newer approaches include endoscopic techniques. This review aims to summarize current diagnostic approaches and critically evaluates the evidence for the efficacy of available treatments.

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Section: Role Of Upper Endoscopy and Biopsymentioning

confidence: 99%

Optimal management of severe symptomatic gastroesophageal reflux disease

Talley

Irani

2020

J. Intern. Med.

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“…Even the Enhanced Recovery After Surgery Society acknowledges that these practices may result in increased gastric volume at the time of induction for patients with diabetes, obesity, and abdominal pathology. 10 In addition, patients presenting for urgent or emergent surgery have been found in multivariate analysis to be 27 times more likely to have a full stomach before induction, regardless of fasting time. 4 However, the category of urgent surgery is particularly vague; one could argue that all inpatient surgeries and many outpatient surgeries are in fact urgent.…”

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confidence: 99%

“…Hiatal hernias of this length are considered clinically significant and are associated with acid regurgitation and heartburn symptoms. 9 These findings are especially concerning since a recent prospective study found that 28% of surgical patients who were compliant with the American Society of Anesthesiologists' (ASA) fasting guidelines had >1.5 mL/kg seen on gastric ultrasound before induction. 3 Another recent prospective study found similar results: 26% of patients presenting for elective surgery and 64% of patients presenting for urgent or emergent surgery had intermediate or full stomachs.…”

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Is It Time to Abandon Routine Mask Ventilation Before Intubation?

Min¹,

Rabinowitz²,

Hess

2021

Anesthesia &Amp; Analgesia

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“…A recent study showed that a hiatal hernia as seen by upper endoscopy was present in 68% of the population in a county in Sweden. 1 The 2 basic types of a hiatal hernia are sliding hernias (SHH), characterized by the gastroesophageal junction (GEJ) in the chest above the fundus of the stomach, and paraesophageal hernias (PEH), where the gastric fundus is in the chest and located above the GEJ. In the rare Type II PEHs the GEJ remains in the abdomen whereas the fundus slips up into the chest.…”

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The Development and Natural History of Hiatal Hernias

et al. 2020

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The aim of this study was to use barium upper gastrointestinal series (UGI) to evaluate the development and natural history of a hiatal hernia. Summary of Background Data: Hiatal hernias are common but the natural history of sliding and paraesophageal type hernias is poorly understood. Methods: We reviewed UGI reports from 1987 to 2017 using a word scanning software program to identify individuals that had a hiatal hernia.Only those with at least 2 UGI studies 5 or more years apart were selected. The studies were then reviewed. Results: There were 89 individuals that met inclusion criteria. Twenty-one people had no hiatal hernia on initial UGI and over a median of 99 months a sliding hiatal hernia (SHH) developed in 16 and a PEH developed in 5 people. A SHH was present on initial UGI in 55 people and at a median of 84 months subsequent UGI showed the SHH was stable in 11 (20%), increased in size in 30 (55%), and changed to a PEH in 14 people (25%). In 13 people a PEH was present on initial UGI and over a median of 97 months it was stable in 5 and increased in size in 8 people (62%). Conclusions: We showed that both SHH and PEH can develop over time and that the majority of both increased in size on follow-up UGI study. Further, 25% of SHH became a PEH over time. Recognizing an increase in size or change in type of a hiatal hernia may be clinically relevant to help understand changing or worsening symptoms in an individual.

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Identifying clinically relevant sliding hiatal hernias: a population-based endoscopy study

Abstract: Only reflux symptoms could be attributed to sliding hiatal hernias. Hiatal hernias less than 2 cm should be considered clinically insignificant.

Cited by 12 publications

References 17 publications

Optimal management of severe symptomatic gastroesophageal reflux disease

Optimal management of severe symptomatic gastroesophageal reflux disease

Is It Time to Abandon Routine Mask Ventilation Before Intubation?

The Development and Natural History of Hiatal Hernias

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