Hiatal hernia, reflux esophagitis and Barrett's esophagus: endoscopic correlation

Introduction: It has been proposed that hiatal hernia (HH) is a risk factor during gastro-esophageal reflux disease (GERD) and its complications, particularly erosive esophagitis. Aims: To evaluate the prevalence of HH and its correlation with the presence of reflux esophagitis, Barrett's esophagus and the severity of esophagitis. Patients/Methods: The results of upper gastrointestinal endoscopies performed in 2004 were evaluated. The presence or absence of HH, its correlation with the presence of esophagitis and Barrett's esophagus, the severity of esophagitis (according to Los-Angeles classification) were noted. The distribution of HH by age and gender was also assessed in this retrospective analysis. Results: Of 2323 patients undergoing upper endoscopy, 1355 (58.3%) had reflux esophagitis and/or Barrett'esophagus, 968 (41.7%) had no esophageal lesions. HH was confirmed endoscopically in 692 (29.8%) of cases. HH was found in 41% of patients with esophagitis, 39% with Barrett's esophagus, and 6% of patients with no esophagitis. HH was significantly associated with the presence of more severe (Los-Angeles C/D) esophagitis. HH patients belonged to an older age group, but no definite gender effect was observed. Conclusions: HH is a major risk factor for severe disease in GERD patients. HH is a predictive factor for the presence of Barrett's esophagus.