# Hiatal Hernia Size and Reflux Parameters in Gastro-Oesophageal Reflux Disease: Evidence From a Retrospective Cohort

## TL;DR

This study found that hiatal hernias larger than 2 cm are linked to more severe acid reflux but not to higher symptom scores or symptom correlation.

## Contribution

The study provides new evidence on the specific relationship between hiatal hernia size and pathological reflux in GORD patients.

## Key findings

- Hiatal hernia size above 2 cm was significantly associated with pathological reflux (p=0.017).
- Age was significantly associated with hiatal hernia size, DeMeester score, and symptom probability (p-values < 0.05).
- Smoking was significantly associated with higher DeMeester scores (p=0.027).

## Abstract

Background

Hiatal hernia is commonly associated with gastro-oesophageal reflux disease (GORD). However, the relationship between hernia size and reflux severity remains unclear. This study aimed to assess the impact of the hiatal hernia size on DeMeester score, symptom correlation, and presence of pathological reflux on pH studies. The study also looked at the impact of various characteristics, including age, smoking, alcohol consumption, body mass index (BMI), and presence of oesophagitis and/or dysmotility, on DeMeester score, symptom correlation, and presence of pathological reflux on pH studies.

Methods

The study was conducted in an upper gastrointestinal surgery unit located in the North West of England. All patients aged 18 and above who underwent laparoscopic fundoplication for GORD between January 2017 and June 2023 were included.

Results

A total of 115 patients with a median age of 54 years were included. Patients' age was found to have a statistically significant association with hiatal hernia size above 2 cm, DeMeester score, and symptom association probability with p-values of 0.011, 0.021, and 0.030, respectively. Hiatal hernia size above 2 cm was found to have a statistically significant association with pathological reflux (p=0.017). The association of smoking with DeMeester score was found to be significant (p=0.027). Hiatal hernia size was not found to have a statistically significant association with DeMeester score, symptom index, or symptom association probability (p=0.115, p=0.315, and p=0.904, respectively).

Conclusion

Hiatal hernia size above 2 cm was found to have a statistically significant association with pathological reflux on pH studies, but there was no association found with elevated DeMeester score above 14.72 or symptom correlation indices.