Association of hiatal hernia and gastroesophageal reflux: correlation between presence and size of hiatal hernia and 24-hour pH monitoring of the esophagus.

The relationship of hiatal hernia to gastroesophageal reflux disease remains controversial. Previous endoscopic and radiologic studies of hiatal hernia and reflux esophagitis have shown that hiatal hernia is a poor predictor of the presence of endoscopic esophagitis, especially for smaller hernias. Similar correlations with 24-hr pH monitoring have not been done. The purpose of this study was to determine if there is a correlation between the presence and size of hiatal hernias and gastroesophageal reflux using 24-hr pH monitoring as a measure of the degree of reflux.We reviewed the barium esophagograms and the results of pH monitoring of the esophagus in 319 patients (161 women and 158 men; mean age, 51 years). The presence and size of hiatal hernia were determined from the radiographic examination; size was categorized as "minimal" or "larger" (> or = 2 cm axial length). An abnormal result of pH monitoring was defined as a pH less than 4 for 6% or more of the 24-hr observation time.Abnormal results of pH monitoring were found in 61 (31%) of 199 patients with hiatal hernia compared with 21 (18%) of 120 patients without hiatal hernia (p < .05). Abnormal findings of pH monitoring were present in 33 (35%) of 95 patients with a larger hiatal hernia versus 28 (27%) of 104 patients with a minimal hiatal hernia (p > .05); a significant difference (p < .05) was observed when patients without hiatal hernia were compared with those with a larger hiatal hernia.Most patients in this study had normal results of pH monitoring of the esophagus regardless of the presence or absence of hiatal hernia. However, patients with larger hiatal hernias were more likely to have abnormal findings on pH monitoring; hiatal hernias of minimal size were a poorer predictor of the presence of abnormal gastroesophageal reflux.