The role of the hiatus hernia in gastro‐oesophageal reflux disease

Abstract

A sliding hiatus hernia disrupts both the anatomy and physiology of the normal antireflux mechanism. It reduces lower oesophageal sphincter length and pressure, and impairs the augmenting effects of the diaphragmatic crus. It is associated with decreased oesophageal peristalsis, increases the cross-sectional area of the oesophago-gastric junction, and acts as a reservoir allowing reflux from the hernia sac into the oesophagus during swallowing. The overall effect is that of increased oesophageal acid exposure. The presence of a hiatus hernia is associated with symptoms of gastrooesophageal reflux, increased prevalence and severity of reflux oesophagitis, as well as Barrett's oesophagus and oesophageal adenocarcinoma. The efficacy of treatment with proton pump inhibitors is reduced. Our view on the significance of the sliding hiatus hernia in gastrooesophageal reflux disease has changed enormously in recent decades. It was initially thought that a hiatus hernia had to be present for reflux oesophagitis to occur. Subsequently, the hiatus hernia was considered an incidental finding of little consequence. We now appreciate that the hiatus hernia has major patho-physiological effects favouring gastro-oesophageal reflux and hence contributing to oesophageal mucosal injury, particularly in patients with severe gastro-oesophageal reflux disease.

Laryngopharyngeal reflux in patients with reflux esophagitis

“…It is associated with decreased esophageal peristalsis; it also increases the cross-sectional area of the esophago-gastric junction and acts as a reservoir allowing reflux from the hernia sac into the esophagus during swallowing. The presence of a hiatus hernia is associated with symptoms of gastroesophageal reflux, and increased prevalence and severity of RE [27] . Because the presence of a hiatus hernia would increase esophageal acid exposure, it is emerging as an important factor in the pathogenesis of GERD [27] .…”

“…The presence of a hiatus hernia is associated with symptoms of gastroesophageal reflux, and increased prevalence and severity of RE [27] . Because the presence of a hiatus hernia would increase esophageal acid exposure, it is emerging as an important factor in the pathogenesis of GERD [27] . In our study, a confirmed hiatus hernia was found to be a risk factor contributing to LPR in the patients with RE.…”

“…Hiatus hernias have a higher detection rate in Western populations, ranging between 14.5% and 22% [27] . In the Far East, the prevalence rate is much lower, 7% of 464 subjects in Taiwan [28] , 2.9% of 11 943 subjects in Singapore [29] , and 17.5% of 6010 individuals in Japan were reported [30] .…”

“…Further work is still needed to understand how a hiatus hernia influences the progression of GERD and its complications. At present, a hiatus hernia is known to be a marker of severe GERD [27] and must have a contributing effect in the pathogenesis of LPR.…”

Halimeter ppb Levels as the Predictor of Erosive Gastroesophageal Reflux Disease

“…Only a few studies 19,20 about the relationship of halitosis and GERD have been reported and these a scant studies were all based on either subjective analyses of halitosis symptom or self reported questionnaire, a weak proof of previous reports to ascertain the connection between halitosis and GERD. In order to document that halitosis might be a frequent associated symptom of GERD and could be one of extraesophageal manifestations of GERD, detailed objective measurement of VSCs should be presented.…”