# 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.

## Key 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.