Clinical significance of hiatus hernia on Barrett’s oesophagus: a scoping review

TL;DR

This review explores how hiatal hernia affects Barrett’s oesophagus, a condition that can lead to cancer, and suggests hernia size may influence disease progression and treatment.

Contribution

This scoping review systematically evaluates the clinical significance of hiatal hernia in Barrett’s oesophagus, highlighting its role in disease onset and treatment outcomes.

Findings

Hiatal hernia is strongly associated with Barrett’s oesophagus development, especially with larger hernia sizes.

Hiatal hernia may reduce the effectiveness of radiofrequency ablation treatment for Barrett’s oesophagus.

Surgical repair of large hiatal hernias may benefit patients with Barrett’s oesophagus by reducing reflux.

Abstract

Hiatal hernia (HH) is commonly observed in patients with Barrett’s oesophagus (BO), a premalignant condition that may progress to oesophageal adenocarcinoma (OAC). While HH has been implicated in BO pathogenesis, it is not formally recognised as a major risk factor in leading international clinical guidelines. This systematic scoping review aimed to evaluate the role of HH in the development, progression, and treatment outcomes of BO.

A systematic scoping review was conducted, searching through databases (PubMed, Medline, Embase, Scopus).

A total of sixty-six articles were included with majority comprised of observational studies. HH was strongly associated with BO development, particularly in cases with larger hernia size (> 2–4 cm) and long-segment BO. While inconsistent, there could BO a trend towards dysplastic and malignant progression of BO in HH. HH may impair the efficacy of radiofrequency ablation, with larger hernias requiring more treatment sessions.

Current evidence supports HH as a significant risk factor for BO onset. Its role in progression and management warrants further investigation. Surgical repair may be beneficial in selected asymptomatic patients, especially those with hernias ≥ 4 cm and established BO, to restore the gastro-oesophageal anatomy and eliminate reflux-prone micro-environment.

The online version contains supplementary material available at 10.1007/s00423-026-03981-z.

Figures