title: Is the severity of gastroesophageal reflux dependent on hiatus hernia size?
abstract: OBJECTIVE
  To determine if the severity of gastroesophageal reflux disease is dependent on the size of a hiatus hernia.
  
  
  METHODS
  Seventy-five patients with either a small (n = 25), medium (n = 25) or large (n = 25) hiatus hernia (assessed by high resolution esophageal manometry) were investigated using 24-h esophageal monitoring and a self-assessed symptom questionnaire. The questionnaire comprised the following items, each graded from 0 to 3 according to severity: heartburn; pharyngeal burning sensation; acid regurgitation; and chest pain.
  
  
  RESULTS
  The percentage total reflux time was significantly longer in the group with hernia of 5 cm or more compared with the group with a hernia of < 3 cm (P < 0.002), and the group with a hernia of 3 to < 5 cm (P < 0.04). Pharyngeal burning sensation, heartburn and acid regurgitation were more common with large hernias than small hernias, but the frequency of chest pain was similar in all three hernia groups.
  
  
  CONCLUSIONS
  Patients with a large hiatus hernia are more prone to have pathological gastroesophageal reflux and to have more acid symptoms than patients with a small hiatus hernia. However, it is unlikely that patients with an absence of acid symptoms will have pathological reflux regardless of hernia size.
authors.affiliation: Thomas Franzén, Lita Tibbling, Faculty of Health and Sciences, Linköping University, Department of Surgery, Vrinnevi Hospital Norrköping, SE-601 82 Norrköping, Sweden.
authors.forename: Thomas
authors.initials: T
authors.lastname: Franzén
authors.affiliation: Thomas Franzén, Lita Tibbling, Faculty of Health and Sciences, Linköping University, Department of Surgery, Vrinnevi Hospital Norrköping, SE-601 82 Norrköping, Sweden.
authors.forename: Lita
authors.initials: L
authors.lastname: Tibbling
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D005764:Gastroesophageal Reflux / Q000175:diagnosis* / Q000503:physiopathology; D006551:Hernia, Hiatal / Q000175:diagnosis* / Q000503:physiopathology; D006801:Humans; D008297:Male; D008365:Manometry / Q000379:methods; D008875:Middle Aged; D011446:Prospective Studies; D011795:Surveys and Questionnaires; D055815:Young Adult
keywords: Acid reflux; Heartburn, Hiatus hernia