The Relationship Between Hiatal Hernia Size, Specific Clinical Symptoms, and Endoscopic Mucosal Changes
Background: Hiatal hernia (HH) is a frequent anatomical abnormality often associated with gastroesophageal reflux disease (GERD). However, the exact relationships between the size of the hernia, the clinical symptoms, and the appearance and extent of endoscopic mucosal changes are subjects of active clinical interest and ongoing research. These relationships are important to understand, for purposes of enhancing optimization of diagnostic methods and optimizing management strategies.
Aim: This study aimed to investigate the relationship between hiatal hernia size, specific clinical symptoms, and endoscopic mucosal changes in patients presenting with reflux symptoms at a tertiary care center.
Methodology: A descriptive cross-sectional study was conducted with 416 consecutive patients who had dyspeptic symptoms consistent with hiatal hernia. All patients underwent upper gastrointestinal endoscopy. Hiatal hernia size was measured, by the distance from the Z-line (squamo-columnar junction) to the diaphragmatic indentation. Clinical symptoms (heartburn, regurgitation, epigastric pain, dysphagia) and endoscopic mucosal changes (reflux oesophagitis using Los Angeles classification, presence of bile, mucosal prolapse, bleeding) were recorded. Statistical analyses were utilized to analyze associations between symptoms, endoscopic changes (Chi-Square, Fischer’s exact), and regression (binary logistic), with p<0.05 being statistically significant.
Results: The most frequently reported symptom was heartburn (66.6%), followed by epigastric pain (61.5%). The largest size of a hiatal hernia being 2cm, and 3cm displayed similar frequencies (46.9% for each size). A significant relationship was reported between hiatal hernia size (≥3cm), and regurgitation (p<0.001); abdominal tenderness (p<0.001), reflux oesophagitis (p=0.020), and mucosal prolapse (p=0.001). In addition, hiatal hernia size had a statistically significant positive relationship with reflux oesophagitis severity (GERD grading) whereby hiatal hernia size 3cm or greater were principally associated with Grade C oesophagitis (p<0.001). Furthermore, age (p=0.004) and body mass index (BMI) (p<0.001) were also statistically significant relationship with variable (hiatal hernia size).
Conclusion: This research demonstrated an exact, significant association between an increasing hiatal hernia size and certain symptoms, such as regurgitation, and more severe endoscopic mucosal changes; especially higher-grade reflux oesophagitis and mucosal prolapse. Hiatal hernia size is one of the key determinants of both clinical and endoscopic manifestations of the disease, emphasizing the benefit of its precise endoscopic assessment in symptomatic patients.
Keywords: Hiatal Hernia Size, Clinical Symptoms, Endoscopic Mucosal Changes, Reflux Oesophagitis, GERD, Endoscopy.
