PREVALENCE OF HIATAL HERNIA IN PATIENTS WITH ACHALASIA
Jose Peralta-Figueroa*2, Janette Furuzawa-Carballeda3, Enrique Coss-Adame4, Miguel A. Valdovinos5, Sofia Narvaez-Chavez2, Hector Olvera-Prado2, Fidel López-Verdugo2, Oscar Santes1, Gonzalo Torres-Villalobos2
1Surgery, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico, Distrito Federal, Mexico; 2Cirugía Experimental, Instituto Nacional de Ciencias Médicas y Nutrición Salvado Zubirán, Ciudad de Mexico, Mexico; 3Inmunología y Reumatología, Instituto Nacional de Ciencias Médicas y Nutrición Salvado Zubirán, Ciudad de Mexico, Mexico; 4Gastroenterología, Instituto Nacional de Ciencias Médicas y Nutrición Salvado Zubirán, Ciudad de Mexico, Mexico; 5Gastroenterología, Instituto Nacional de Ciencias Médicas y Nutrición Salvado Zubirán, Ciudad de Mexico, Mexico
Background and Aim
Achalasia is a rare disorder of esophageal motility with a reported prevalence of 1 per 100,000 people. Hiatal hernia is a frequent finding in the general population (30-50%). Few studies have addressed its prevalence in patients with achalasia; however, it has been reported to be lower (2-14%). The reason for this difference is unclear. We aimed to determine the prevalence of hiatal hernia in achalasia patients.
Materials and Methods
Retrospective study of patients diagnosed with achalasia at a single center from 2012 to 2018. Patients with a history of thoracic or upper abdominal surgery were excluded. Demographic data, symptoms, body mass index (BMI) and achalasia subtype were collected from clinical files. High-resolution manometry, esophagogram, and upper endoscopy were inspected looking for hiatal hernia. Continuous variables were displayed as mean (standard deviation). The data was statistically analyzed with SPSS 3.3.
Results
One hundred six patients were included, 60.4% were females. The mean age of the patients was 40.9 years (SD 14.5). The mean BMI was 24.1 (SD 5.2). Patients reported a median time of symptoms evolution of 18 months (SD 8-36). Type II achalasia was predominant (69.2%), followed by type I achalasia (28.8%) and type III (1.9%). A hiatal hernia was detected in 4 (3.8%) patients, all of them with type II achalasia. The four patients had a sliding hiatal hernia. The diagnosis was made with upper endoscopy in 3 patients and high-resolution manometry in 1 patient. When comparing patients with and without hiatal hernia, no significant difference was found in any of the variables examined.
Conclusion
The prevalence of hiatal hernia in patients with achalasia is lower than the reported in the general population. With our results it is not possible to establish a reason; nevertheless, it has been described that the length of the esophageal body of patients with achalasia is slightly longer compared to healthy individuals. We hypothesize that this factor could be associated with this lower prevalence.
Table 1. Demographic and clinical data.
| Demographic | Total, n | 106 |
| Female, n(%) | 64(60.4) | |
| Male, n(%) | 42(39.6) | |
| Age, meanąSD(years) | 40.9ą14.5 | |
| BMI | With hiatal hernia, meanąSD | 26.5ą4.3 |
| Without hiatal hernia, meanąSD | 24ą5.2 | |
| Type of achalasia | I, n(%) | 30 (28.8) |
| II n(%) | 72 (69.2) | |
| III n(%) | 2 (2) | |
| Clinical variables | Dysphagia, n (%) | 105(99.1) |
| Weight loss, meanąSD | 13.1ą9.8 | |
| Hearthburn, n (%) | 65(61.9) | |
| Regurgitation, n(%) | 98(92.5) | |
| Symptomatic scores | EAT-10, meanąSD | 29.7ą9.4 |
| Eckardt, meanąSD | 9.1ą2.8 | |
| GERD-HRQL, meanąSD | 24.2ą12.8 |
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