Hiatal Hernia and Conclusive Gastroesophageal Reflux Disease: Size Matters
4 affiliations
- 1Department of Internal Medicine, Pontificia Universidad Javeriana, Bogotá Dc Colombia
- 2Department of Internal Medicine, Hospital Universitario San Ignacio, Bogotá Dc Colombia
- 3Division of Gastroenterology, Hospital Universitario San Ignacio, Bogotá Dc Colombia
- 4Division of Gastroenterology, Washington University School of Medicine St Louis MO USA
Abstract
Background/Aims: The Lyon Consensus considers hiatal hernia (HH) as a supportive metric for the diagnosis of gastroesophageal reflux disease (GERD) when evidence is inconclusive; however, HH size is not taken into consideration. We aimed to correlate HH size with conclusive evidence of GERD from multichannel intraluminal impedance and pH monitoring (MII-pH) and upper endoscopy.
Methods: We analyzed a retrospective consecutive cohort of patients with suspected GERD with and without HH on high-resolution manometry who also underwent upper endoscopy and MII-pH monitoring off therapy within a ≤6 month interval. HH was categorized as none, small (<3 cm), medium (3–5 cm), or large (>5 cm). Pathological acid exposure time (AET, >6%), endoscopic GERD findings, and adjunctive MII-pH metrics were compared and correlated between subsets based on the presence and size of HH.
Results: Of the 456 included patients, 337 (73.9%) had HH as follows: small HH, 114; medium HH, 117; and large HH, 106. Pathological AET showed a stepwise increase from 19.3% in the no HH group to 41.2% in the small HH group, 51.3% in the medium HH group, and 83.0% in the large HH group (P < 0.001). The prevalence of erosive esophagitis increased similarly (7.6%, 14.9%, 17.9%, and 43.4%, respectively; P < 0.001). DeMeester score, total reflux episodes (TREs), and mean nocturnal baseline impedance (MNBI) showed similar findings (all P < 0.001), but the prevalence of peptic stricture (P = 0.263) and Barrett’s esophagus did not differ significantly (P = 0.108). HH size correlated positively with AET (rho = 0.49) and TRE (rho = 0.53) and negatively with MNBI (rho = -0.46; all P < 0.001).
Conclusions: Evidence for conclusive GERD increases with HH size, supporting its role as a key anatomical marker for GERD assessment using the Lyon Consensus 2.0 criteria.
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BibTeX
@article{hernandez2026hiatal,
title = {{Hiatal Hernia and Conclusive Gastroesophageal Reflux Disease: Size Matters}},
author = {Juan S. Hernández and Albis C. Hani and Oscar M. Muñoz and Juan P. Garcia and Raúl A. Cañadas and Freddy A. Ávila and Ferney Arias and C. Prakash Gyawali},
journal = {Journal of Neurogastroenterology and Motility},
year = {2026},
month = oct,
doi = {10.5056/jnm26046},
url = {https://doi.org/10.5056/jnm26046},
note = {CC BY-NC 4.0},
}
RIS
TY - JOUR
TI - Hiatal Hernia and Conclusive Gastroesophageal Reflux Disease: Size Matters
AU - Juan S. Hernández
AU - Albis C. Hani
AU - Oscar M. Muñoz
AU - Juan P. Garcia
AU - Raúl A. Cañadas
AU - Freddy A. Ávila
AU - Ferney Arias
AU - C. Prakash Gyawali
PY - 2026
DA - 2026/10/31
JO - Journal of Neurogastroenterology and Motility
DO - 10.5056/jnm26046
UR - https://doi.org/10.5056/jnm26046
AB - Background/Aims: The Lyon Consensus considers hiatal hernia (HH) as a supportive metric for the diagnosis of gastroesophageal reflux disease (GERD) when evidence is inconclusive; however, HH size is not taken into consideration. We aimed to correlate HH size with conclusive evidence of GERD from multichannel intraluminal impedance and pH monitoring (MII-pH) and upper endoscopy. Methods: We analyzed a retrospective consecutive cohort of patients with suspected GERD with and without HH on high-resolution manometry who also underwent upper endoscopy and MII-pH monitoring off therapy within a ≤6 month interval. HH was categorized as none, small (<3 cm), medium (3–5 cm), or large (>5 cm). Pathological acid exposure time (AET, >6%), endoscopic GERD findings, and adjunctive MII-pH metrics were compared and correlated between subsets based on the presence and size of HH. Results: Of the 456 included patients, 337 (73.9%) had HH as follows: small HH, 114; medium HH, 117; and large HH, 106. Pathological AET showed a stepwise increase from 19.3% in the no HH group to 41.2% in the small HH group, 51.3% in the medium HH group, and 83.0% in the large HH group (P < 0.001). The prevalence of erosive esophagitis increased similarly (7.6%, 14.9%, 17.9%, and 43.4%, respectively; P < 0.001). DeMeester score, total reflux episodes (TREs), and mean nocturnal baseline impedance (MNBI) showed similar findings (all P < 0.001), but the prevalence of peptic stricture (P = 0.263) and Barrett’s esophagus did not differ significantly (P = 0.108). HH size correlated positively with AET (rho = 0.49) and TRE (rho = 0.53) and negatively with MNBI (rho = -0.46; all P < 0.001). Conclusions: Evidence for conclusive GERD increases with HH size, supporting its role as a key anatomical marker for GERD assessment using the Lyon Consensus 2.0 criteria.
SN - 2093-0879
SN - 2093-0887
ER -