WHY HIATAL HERNIA IN ACHALASIA IS SO UNCOMMON?
Ana López-Ruiz*1,2, Enrique Coss-Adame1,3, Janette Furuzawa-Carballeda1,4, Miguel A. Valdovinos1,3, Rebeca Cesati-Zaragoza1,2, Ricardo González-Jaramillo1,2, Sandra Dueñas-Almaguer1,2, Josué Sánchez-Gómez1,2, Gonzalo Torres-Villalobos1,5
1Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico, CDMX, Mexico; 2Department of Experimental Surgery, Mexico, CDMX, Mexico; 3Department of Gastroenterology, Mexico, CDMX, Mexico; 4Department of Immunology and Rheumatology, Mexico, CDMX, Mexico; 5Department of Surgery and Experimental Surgery,, Mexico, CDMX, Mexico
Introduction: Hiatal hernia (HH) is a frequent finding in the general population (30-50%). However, few studies have addressed the prevalence of HH in achalasia patients (2–14%) and no possible explanation for this has been proposed.
Aim: To determine the prevalence of HH in patients with achalasia and to compare their esophageal lengths with 2 control groups: 1) patients with GERD and 2) healthy volunteers (HV). To determine if there were differences in terms of symptoms between the HH and non-HH subgroups.
Methods: This retrospective study included 90 achalasia patients who had not undergone surgery, 22 GERD patients and 30 HI. All were recruited at a single center from 2012 to 2018. High-resolution manometry (sitting position), barium swallow, and upper endoscopy were performed to diagnose HH in the achalasia and GERD groups (HH was defined when the separation between the squamocolumnar junction and the diaphragmatic impression is greater than 2 cm). Symptoms were evaluated with: Eckardt, EAT-10, and GERD-HRQL. The esophageal length was measured by High-resolution manometry from the inferior border of the upper sphincter to the superior border of the lower sphincter. An index of esophageal length versus height was also calculated by dividing esophageal measurement in cm by height in cm. We averaged 3 resting measurements for a baseline length (BL) and 10 measurements after each one of the swallows for a post-swallow length (PSL).
Results: There was no difference in the mean height of achalasia patients (160 cm) compared to HV (163 cm) p=0.1. However, GERD patients were significantly taller (167cm) than the achalasia patients (P=0.001). The prevalence of HH in achalasia patients was 2.2% (n=2) vs. 81.1% (n=16) in GERD patients (P<0.001). There were no differences between BL and PSL in any of groups. Achalasia patients had a greater BL (23.4 cm) compared to GERD patients (BL=21.9 cm; P=0.01) and HV (BL=21.37cm; P= 0.001). The BL index in achalasia was higher (14.6) compared with GERD (13.05) (P<0.0001) and HV(13.22) P<0.0001. Among the HH and non-HH subgroups of the achalasia group there were no differences in symptom scores. Likewise, in the GERD group the HH and non-HH subgroups showed no differences in symptom scores.
Conclusion: The prevalence of hiatal hernia in achalasia patients is lower than the reported in general population. Patients with achalasia have a longer esophagus compared to GERD patients and healthy volunteers. This finding might explain why patients with achalasia have a lower hiatal hernia prevalence.
Back to 2020 Abstracts