P2403 - Hiatal Hernias Associated With Acid Reflux: Size Larger Than 2 cm Matters

Dariush Shahsavari, MD¹, Michael S. Smith, MD, MBA², Zubair Malik, MD³, Henry P. Parkman, MD^3
1Temple University, Augusta, GA; ²Mount Sinai West & Mount Sinai Morningside Hospitals, New York, NY; ³Temple University, Philadelphia, PA

Introduction: Hiatal hernia (HH) is associated with gastroesophageal reflux (GERD). Correlation between HH size and GERD is not well-defined. We aimed to evaluate association between HH size on high-resolution esophageal manometry (HREM) and reflux on esophageal multiluminal impedance-pH study (MII-pH) studies and to define HH sizes associated with GERD severity.

Methods: Results of HREM and MII-pH studies performed between 2017-2020 were extracted using Visual Basic® coding language. Patients with achalasia and esophagogastric junction outflow obstruction were excluded. Kruskal-Wallis and pairwise comparison with Bonferroni correction were used to detect significant HH size. Multivariable binary logistic regression models and Spearman’s correlation test were used to analyze the association between HH size and other parameters.

Results: Of the 1,244 patients who had both HREM and MII-pH studies (64.5% males, age 54.1±15 years), 600 patients (49.2%) had no HH, 367 (30%) had HH 0.1-1.9 cm, 212 (17%) had HH 2-3.9 cm, and 45 (3.6%) HH ≥ 4 cm. Esophageal acid exposure time (AET) averaged 9.1%±11.7%, with 59.3±46.8 reflux episodes detected by impedance. Larger HH size was associated with older age (r=0.23, p< 0.01), lower LES basal and residual pressures (r=-0.36 and r=-0.41, all p< 0.01), higher AET (r=0.17, p< 0.01), number of acidic refluxes (r=0.18, p< 0.05), and impedance reflux episodes (r=0.20, p< 0.01). Pairwise comparisons between HH of sizes of 1 cm apart showed HH ≥ 2 cm being significantly associated with higher AET, a higher number of pH refluxes, higher DeMeester score, and more reflux episodes detected by impedance (p< 0.05). When adjusted for LES basal and residual pressure, and mean DCI in multivariable models, patients with larger HH size were more likely to have AET≥6% (OR=1.24; 95% CI:1.1-1.4, p< 0.001), impedance episodes ≥ 80 (OR=1.3; 95% CI:1.2-1.5, p< 0.001), and higher DeMeester score≥14.7 (OR=1.12; 95% CI:1.01-1.25, p< 0.001). Among other variables, only LES basal and residual pressures were slightly associated with impedance episodes ≥ 80 (OR=0.98 and OR=0.96, p< 0.05).

Discussion: Increasing hiatal hernia size as detected on HREM was associated with older age, higher AET, reflux episodes detected by impedance, and DeMeester score. HH larger than 2 cm were associated with significantly worsened GERD parameters. This study demonstrates the importance of larger hiatal hernias, particularly above 2 cm, as they are associated with more severe GERD.



Disclosures:


Dariush Shahsavari, MD¹, Michael S. Smith, MD, MBA², Zubair Malik, MD³, Henry P. Parkman, MD³. P2403 - Hiatal Hernias Associated With Acid Reflux: Size Larger Than 2 cm Matters, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.