Hiatal Hernia: risk factors, clinical and endoscopic aspects in gastroscopy

Aims Hiatal hernia (HH) results from herniation of the stomach through the diaphragm. The objective of the present study was to investigate the frequency rate of HH among patients who underwent esophagogastroduodenoscopy (EGD) according to their age, gender, and procedural indication. Additionally, we aimed to analyze the clinical and endoscopic aspects associated with HH.

Methods A multicenter, retrospective study including all EGD procedures conducted across seven endoscopy departments between the years 2016 and 2021. Demographic information, procedural indications, and findings from the initial EGD were collected and subjected to statistical analysis using IBM SPSS version 26.

Results Out of the 162,608 EGDs examined, 96,369 (59.3%) involved female patients, with a mean age of 53.9±15.1 years. HH was identified in 39,619 (24.4%) of all EGDs performed, comprising small HH in 31,562 (79.6%), large HH in 3547 (9%) and unknown size among 4510 (11.4%). The prevalence of HH among patients who underwent EGD increased with age, reaching 16.5% among the age group≤50 years and 37.3% in those≥81 years. Regarding indications for procedure, HH was diagnosed in 11,370 (38.7%) of patients presenting with heartburn, 31.5% with dysphagia, 28.5% with positive fecal occult blood tests, and 24.3% of patients before undergoing bariatric surgery. In addition, age (OR 1.03, p<0.001; 95% CI [1.029,1.031]), female gender (OR 2.319, p<0.001; 95% CI [1.287,1.351]), reflux symptoms (OR 2.279, p<0.001; 95% CI [2.206-2.355]), and dysphagia (OR of 1.450, p<0.001, 95% CI 1.359-1.547) were identified as predictors for HH.

Conclusions Risk factors for hiatal hernia diagnosed through EGD in symptomatic patients was shown to be advanced age, female gender, and the presence of heartburn or dysphagia.

Conflicts of interest

Authors do not have any conflict of interest to disclose.

Publication History

Article published online:
15 April 2024