title: Impact of hiatal hernia on pediatric dyspeptic symptoms.
abstract: OBJECTIVE
  Hiatal hernia (HH) affects from 10% to 50% of adult population. The correlation between HH, gastroesophageal reflux disease, dyspeptic symptoms, and esophagitis has long been known in adults. The primary objective of our prospective observational study was to estimate the prevalence of HH in children undergoing esophagogastroduodenoscopy (EGD), irrespective of their symptoms.
  
  
  METHODS
  We prospectively enrolled 111 consecutive children (48 boys and 63 girls; mean age 94.9 ± 52.3 months) referred for EGD. In all of the patients a symptomatic score assessment based on the Rome III criteria was used to measure frequency, severity, and duration of gastrointestinal symptoms. HH presence was endoscopically defined; esophagitis presence was evaluated either endoscopically and histologically. Children were divided in 2 age-range groups: <48 months (group 1) and >48 months (group 2).
  
  
  RESULTS
  Twenty-three patients of 111 (20.7%) had evidence of a sliding HH at EGD. In children from group 2, we found a statistically significant association of HH with heartburn (P = 0.03, 95% confidence interval 1-9.3, r = 0.1) and regurgitation (P = 0.003, 95% confidence interval 1.7-20.4, r = 0.3). Regarding esophagitis presence, no association was found at any age either with defined esophagitis or with dilated intercellular spaces.
  
  
  CONCLUSIONS
  Prevalence of HH in our study population was 20.7%. According to our data, HH correlates with the presence of heartburn and regurgitation in children, but not in toddlers. No association was found with esophagitis at any age.
authors.affiliation: *Department of Translational Medical Sciences, Section of Pediatrics †Department of Biomorphological and Functional Sciences, Section of Pathology, University of Naples "Federico II," Italy.
authors.forename: Elena
authors.initials: E
authors.lastname: Scarpato
authors.forename: Maria
authors.initials: M
authors.lastname: D'Armiento
authors.forename: Massimo
authors.initials: M
authors.lastname: Martinelli
authors.forename: Valeria
authors.initials: V
authors.lastname: Mancusi
authors.forename: Severo
authors.initials: S
authors.lastname: Campione
authors.forename: Annalisa
authors.initials: A
authors.lastname: Alessandrella
authors.forename: Annamaria
authors.initials: A
authors.lastname: Staiano
authors.forename: Erasmo
authors.initials: E
authors.lastname: Miele
mesh_terms: D015746:Abdominal Pain; D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004415:Dyspepsia; D016145:Endoscopy, Digestive System; D004941:Esophagitis / Q000150:complications; D005260:Female; D005764:Gastroesophageal Reflux / Q000150:complications; D005767:Gastrointestinal Diseases / Q000150:complications / Q000175:diagnosis; D006356:Heartburn / Q000150:complications; D006551:Hernia, Hiatal / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology*; D006801:Humans; D008297:Male; D011446:Prospective Studies