Prevalence of Hiatal Hernia in Patients Undergoing Endoscopy with Gastroesophageal Reflux Disease

Abstract

Objective: To determine the prevalence of hiatal hernia (HH) in patients undergoing endoscopy with gastroesophageal reflux disease (GERD).

Study Design: Retrospective observational study

Place and Duration of Study: This study was conducted at the department of Medicine and Gastroenterology, Pakistan Air Force Hospital, Islamabad, Pakistan from January 2023 to July 2024.

Methods: The study included patients aged 18 to 45 years who were referred for diagnostic upper gastrointestinal endoscopy due to symptoms suggestive of GERD. Data were collected using a standardized form that captured demographic information, clinical characteristics, and endoscopic findings. HH was defined as a separation of more than 2 cm between the gastroesophageal junction and the diaphragmatic hiatus, as visualized on endoscopy.

Results: A total of 1,135 patients were included in the study. There were 618 (54.4%) male. The mean age was 35.48±5.81 years, while 685 (60.4%) patients were aged between 31 and 45 years. The  mean duration of GERD symptoms was 9.42±3.16 months. HH was identified in 427 (37.6%) patients with GERD. HH was more prevalent among overweight patients (p<0.001), rural residence  (p=0.001), symptom duration of ≥6 months (p<0.001), smoking (39.8% vs. 26.3%, p<0.001), sedentary life-style (p<0.001), family history of GERD (p<0.001), and diabetes mellitus (p=0.004). Regarding presenting features, heartburn (p<0.001), regurgitation (p<0.001), dysphagia (p=0.011), chest pain (p=0.034), nausea (p=0.004), and vomiting (p<0.001) were significantly more prevalent in patients with HH.

Conclusion: This study highlights a high prevalence of HH among patients undergoing endoscopy for GERD, with significant associations with BMI, rural residence, symptom chronicity, smoking, and sedentary behavior.