The Development and Natural History of Hiatal Hernias: A Study Using Sequential Barium Upper Gastrointestinal Series.
Journal
Annals of surgery
ISSN: 1528-1140
Titre abrégé: Ann Surg
Pays: United States
ID NLM: 0372354
Informations de publication
Date de publication:
01 03 2022
01 03 2022
Historique:
pubmed:
11
8
2020
medline:
19
2
2022
entrez:
11
8
2020
Statut:
ppublish
Résumé
The aim of this study was to use barium upper gastrointestinal series (UGI) to evaluate the development and natural history of a hiatal hernia. Hiatal hernias are common but the natural history of sliding and paraesophageal type hernias is poorly understood. 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. 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%). 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.
Sections du résumé
OBJECTIVE
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.
Identifiants
pubmed: 32773629
pii: 00000658-202203000-00020
doi: 10.1097/SLA.0000000000004140
doi:
Substances chimiques
Barium
24GP945V5T
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
534-538Informations de copyright
Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.
Déclaration de conflit d'intérêts
No personal or financial conflicts of interest related to this study for any author. The authors declare no conflict of interest.
Références
Wallner B, Bjor O, Andreasson A, et al. Identifying clinically relevant sliding hiatal hernias: a population-based endsocscopy study. Scand J Gastroenterol 2018; 53:657–660.
Polomsky M, Siddall KA, Salvador R, et al. Association of kyphosis and spinal skeletal abnormalities with intrathoracic stomach: a link toward understanding its pathogenesis. J Am Coll Surg 2009; 208:562–569.
Kahrilas PJ. The role of hiatus hernia in GERD. Yale J Biol Med 1999; 72:101–111.
Lord RV, DeMeester SR, Peters JH, et al. Hiatal hernia, lower esophageal sphincter incompetence, and effectiveness of Nissen fundoplication in the spectrum of gastroesophageal reflux disease. J Gastrointest Surg 2009; 13:602–610.
Polomsky M, Jones CE, Sepesi B, et al. Should elective repair of intrathoracic stomach be encouraged? J Gastrointest Surg 2010; 14:203–210.
Furukawa N, Iwakiri R, Koyama T, et al. Proportion of reflux esophagitis in 6010 Japanese adults: prospective evaluation by endoscopy. J Gastroenterol 1999; 34:441–444.
Ronkainen J, Aro P, Storskrubb T, et al. High prevalence of gastroesophageal reflux symptoms and esophagitis with or without symptoms in the general adult Swedish population: a Kalixanda study report. Scan J Gastroenterol 2005; 20:275–285.
Schlottmann F, Andolfi C, Herbella FA, et al. GERD: presence and size of hiatal hernia influence clinical presentation, esophageal function, reflux profile, and degree of mucosal injury. Am Surg 2018; 84:978–982.
Stylopoulos N, Gazelle GS, Rattner DW. Paraesophageal hernias: operation or observation? Ann Surg 2002; 236:492–500. discussion 500–501.
Windsor CW, Collis JL. Anemia and hiatus hernia. Proc R Soc Med 1968; 61:213–215.
Carrott PW, Markar SR, Hong J, et al. Iron-deficiency anemia is a common presenting issue with giant paraesophageal hernia and resolves following repair. J Gastrointest Surg 2013; 17:858–862.
Schlottmann F, Strassle PD, Patti MG. Surgery for benign esophageal disorders in the US: risk factors for complications and trends of morbidity. Surg Endosc 2018; 32:3675–3682.
Khoma O, Mugino M, Falk GL. Is repairing giant hiatal hernia in patients over 80 worth the risk? Surgeon 2020; 18:197–201.