Incidence and coincidence of hiatus hernia.

Abstract

The frequency of hiatus hernias found incidentally during routine barium meal examinations has been reported on many occasions (Eisen, 1938;Levy and Duggan, 1941;Mendelsohn, 1946;Root and Pritchett, 1938;and Ritvo, 1930), and varies between 0-8% and 2-9%. When the abdominal pressure is increased by any method during the examination, the incidence rises to between 2-1% and 11 8% (Boyd, Harris, Butler, and Donaldson, 1956;Carmichael, 1959;Conway-Hughes, 1956;Sim, 1964;and Hafter, 1958). Stein and Finkelstein (1960), Texter, Van Derstappen, Chejfec, Chvojka, Vidinli, Barborka, and Bundesen (1962), and Wolf and Guglielmo (1957 have shown that even more hernias can be demonstrated if the patient is given barium to swallow when in the prone position with the abdomen compressed. METHODTo find the incidence of hiatus hernia when each patient having a barium meal is given barium to swallow whilst lying prone, 500 consecutive barium meals were studied. All the examinations were done to establish the cause of abdominal pain believed to be due either to peptic ulceration or to gastric neoplasm. Meals which were given to confirm the presence of a clinically suspected hiatus hernia were not included in the 500, nor were those merely to estimate progress of a known gastric ulcer or examinations on patients who had already had gastric surgery. If a hiatus hernia had not already been seen before completing each examination, a single mouthful of barium was given whilst the patient lay prone over a firm bolster some 9 in. in diameter. The barium was watched on the screen as it moved down the oesophagus, and the oesophageal peristaltic waves were examined particularly to see if they continued as far as the diaphragm or not. Gastro-oesophageal reflux was not diagnosed unless the oesophagus filled from below, that is, without giving barium in the prone position. A film was taken of the oesophagus after it had emptied as much as it would and a hiatus hernia was diagnosed only if a ring or groove as described by Maclean (1959) could be identified above the diaphragm and the mucosal pattern of the supradiaphragmatic pouch was continuous with that of the infradiaphragmatic portion of the stomach. When doubt existed on the evidence of either the screening or the film about the presence of a hernia none was reported. RESULTSThe frequency of hiatus hernias for each decade is shown in Table I. The overall incidence is 29-6%. Gastro-oesophageal reflux occurred in 57 of the 148 (38 %) patients with hiatus hernia and was seen in 41 women (45% of those with hernias) and 16 men (29 %).

Incidence of hiatus hernia in asymptomatic subjects.

“…Since the main conclusion results are not significant that may be drawn from a survey of the literature is t group complaining of other that the presence of a hiatus hernia bears an irregular series (p > 0.7 using the x2 relationship to the incidence of upper gastrointestinal hernia in the presence Of symptoms, the correlation of symptoms with other increased, radiological findings should be investigated. It has been shown that the size of the loculus is not related to symptoms (Hiebert and Belsey, 1961;Rex, BLE V Andersen, Bartholomew, and Cain, 1961) and this is PAIN AND HIATUS HERNIA also suggested by (Pridie, 1966) than in our 6 6 50 asymptomatic patients. Unfortunately, a suspension 13 7 35 of barium is more viscous than gastric juice and reflux may be demonstrated by pH measurements in the lower oesophagus in subjects who show no oU55ION radiological reflux (Hill, Chapman, and Morgan, 1961).…”

“…SEX Nearly twice as many men as women were Pridie (1966)' included in the study by chance, but the overall incidence of hernia in each sex was similar-33 % in men, 32 % in women. OBESITY As a rough guide to obesity, an index was calculated by dividing the weight of each patient by his height.…”

“…Each patient first drank a glass of barium in order to reproduce the conditions of the previous study (Pridie, 1966), in which hiatus hernia was looked for at the end of a routine barium meal. He was then placed prone over a bolster and screened.…”

“…Pridie (1966) examined 500 patients lying prone over a bolster and found hiatus hernias in 30%. Since these patients were referred with symptoms suggestive of gastrointestinal disease, the significance of the hiatus hernia and its role in the production of symptoms could not be assessed.…”

Gastroesophageal reflux disease is uncommon in Asia: evidence and possible explanations

“…Barrett's esophagus is the eponym applied to the columnar epithelium-lined lower esophagus that is acquired as a consequence of chronic gas troesophageal reflux [4] . Hiatus hernia, on the other hand, has been defined as a displacement of the gastric mucosa 1.5cm or more above the diaph ragmatic hiatus [5] .…”