title: Size of hiatus hernia correlates with severity of kyphosis, not with obesity, in elderly Japanese women.
abstract: OBJECTIVE
  To investigate whether there is a relationship between hiatus hernia (HH) and kyphosis or obesity in elderly Japanese persons.
  
  
  BACKGROUND
  The causes of HH in the elderly are unclear.
  
  
  METHODS
  We enrolled 147 consecutive patients aged over 50 years in this study. Endoscopic assessment of the size of HH was performed by using a modified Makuuchi classification with grades from 1 (no HH) to 4 (>3 cm). The gastroesophageal flap valve (GEFV) was also graded from I to IV. Kyphosis was evaluated from a lateral photograph by measuring the modified Cobb angle (CA) and calculating the kyphosis index (KI). Body mass index (BMI) was used to evaluate obesity.
  
  
  RESULTS
  In women, there were significant differences of both the CA (analysis of variance, P<0.0001) and KI (Kruskal-Wallis test, P<0.01) between each grade of HH. Differences of the CA (P<0.001) and KI (P<0.001) were also seen between the grades of GEFV. None of these differences were detected in men. In women, the CA (r=0.556, P<0.0001) and KI (P<0.0001) were positively correlated with age, but this was not so in men. Neither sex showed an association between BMI and the grade of either HH or GEFV. However, there was a weak negative correlation between age and BMI in women (r=-0.223, P<0.05) and men (r=-0.334, P<0.05).
  
  
  CONCLUSIONS
  The size of HH is associated with the severity of kyphosis, not with obesity, in elderly Japanese women. Age is a risk factor for both kyphosis and HH.
authors.affiliation: Department of Endoscopy and Endoscopic Surgery, Gunma University Hospital, 3-39-15 Showa-machi, Maebashi, Gunma, Japan. mkusano@showa.gunma-u.ac.jp
authors.forename: Motoyasu
authors.initials: M
authors.lastname: Kusano
authors.forename: Kaoru
authors.initials: K
authors.lastname: Hashizume
authors.forename: Youich
authors.initials: Y
authors.lastname: Ehara
authors.forename: Yasuyuki
authors.initials: Y
authors.lastname: Shimoyama
authors.forename: Osamu
authors.initials: O
authors.lastname: Kawamura
authors.forename: Masatomo
authors.initials: M
authors.lastname: Mori
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D015992:Body Mass Index; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006551:Hernia, Hiatal / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D006801:Humans; D007564:Japan / Q000453:epidemiology; D007738:Kyphosis / Q000150:complications* / Q000000981:diagnostic imaging; D008297:Male; D009017:Morbidity; D009765:Obesity / Q000150:complications* / Q000175:diagnosis; D011446:Prospective Studies; D011859:Radiography; D012307:Risk Factors; D012720:Severity of Illness Index; D012737:Sex Factors