Prevalence of Asymptomatic Hiatal Hernia in Obese Patient in Routine Upper Gastrointestinal Endoscopy Screening and Correlation with BMI

Abstract

Background In obese patients, hiatus hernia (HH) can be asymptomatic or it may present with one or few symptoms such as heartburn, nausea, or vomiting. Routine upper gastrointestinal endoscopy is the most frequent method to determine the presence of any abnormalities including hiatus hernia.Aim The aim of this study is to assess the prevalence of asymptomatic hiatal hernia in obese patients in routine upper GI endoscopy screening and correlation with BMI.Materials and Methods This was an observational retrospective cohort study conducted at King Fahad Specialist hospital-Buraydah, Qassim, Saudi Arabia. The data were extracted from the medical records and electronic charts of all obese patients who had upper gastrointestinal endoscopy screening between January 2017 – December 2019. Data were tabulated in MS Excel and were analyzed using SPSS version 21.Results Among the 690 obese patients, the prevalence of HH was 103 yielding an overall percentage of 14.3%. Chi-square test revealed that the use of Proton-pump inhibitors (PPI) (X2=6.876; p=0.009) and abdominal pain (X2=3.885; p=0.049), shortness of breath (X2=8.057; p=0.005), vomiting (X2=4.302; p=0.038), nausea (X2=4.090; p=0.043) and other HH symptoms (X2=3.897; p=0.048) significantly influenced HH but the BMI level did not (X2=2.126; p=0.345). In multivariate regression model, the use of PPI medication (AOR=0.237; CI=0.074 – 0.760; p=0.023) significantly decreased the risk of HH while vomiting (AOR=1.722; CI=1.025 – 2.890; p=0.040) and nausea (AOR=1.698; CI=1.012 – 2.849; p=0.045) significantly increased the risk of HH.Conclusion Asymptomatic HH among obese patients is not widely prevalent in our region. The use of PPI medications was a protective factor of HH while symptoms such as vomiting and nausea increased the risk of HH. However, there was no evidence found linking BMI to HH as shown in this study.