title: Association between Increased Gastric Juice Acidity and Sliding Hiatal Hernia Development in Humans.
abstract: OBJECTIVE
  Several clinical factors; overweight, male gender and increasing age, have been implicated as the etiology of hiatal hernia. Esophageal shortening due to acid perfusion in the lower esophagus has been suggested as the etiological mechanism. However, little is known about the correlation between gastric acidity and sliding hiatus hernia formation. This study examined whether increased gastric acid secretion is associated with an endoscopic diagnosis of hiatal hernia.
  
  
  METHODS
  A total of 286 consecutive asymptomatic patients (64 were diagnosed as having a hiatal hernia) who underwent upper gastrointestinal endoscopy were studied. Clinical findings including fasting gastric juice pH as an indicator of acid secretion, age, sex, body mass index, and Helicobacter pylori infection status determined by both Helicobacter pylori serology and pepsinogen status, were evaluated to identify predictors in subjects with hiatal hernia.
  
  
  RESULTS
  Male gender, obesity with a body mass index >25, and fasting gastric juice pH were significantly different between subjects with and without hiatal hernia. The cut-off point of fasting gastric juice pH determined by receiver operating curve analysis was 2.1. Multivariate regression analyses using these variables, and age, which is known to be associated with hiatal hernia, revealed that increased gastric acid secretion with fasting gastric juice pH <2.1 (OR = 2.60, 95% CI: 1.38-4.90) was independently associated with hiatal hernia. Moreover, previously reported risk factors including male gender (OR = 2.32, 95% CI: 1.23-4.35), body mass index >25 (OR = 3.49, 95% CI: 1.77-6.91) and age >65 years (OR = 1.86, 95% CI: 1.00-3.45), were also significantly associated with hiatal hernia.
  
  
  CONCLUSIONS
  This study suggests that increased gastric acid secretion independently induces the development of hiatal hernia in humans. These results are in accordance with the previously reported hypothesis that high gastric acid itself induces hiatal hernia development.
authors.affiliation: Department of Gastroenterology, Tokyo Dental College, Ichikawa General Hospital, Ichikawa, Chiba, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Kishikawa
authors.affiliation: Department of Gastroenterology, Tokyo Dental College, Ichikawa General Hospital, Ichikawa, Chiba, Japan.
authors.forename: Kayoko
authors.initials: K
authors.lastname: Kimura
authors.affiliation: Department of Gastroenterology, Tokyo Dental College, Ichikawa General Hospital, Ichikawa, Chiba, Japan.
authors.forename: Asako
authors.initials: A
authors.lastname: Ito
authors.affiliation: Department of Gastroenterology, Tokyo Dental College, Ichikawa General Hospital, Ichikawa, Chiba, Japan.
authors.forename: Kyoko
authors.initials: K
authors.lastname: Arahata
authors.affiliation: Department of Gastroenterology, Tokyo Dental College, Ichikawa General Hospital, Ichikawa, Chiba, Japan.
authors.forename: Sakiko
authors.initials: S
authors.lastname: Takarabe
authors.affiliation: Department of Gastroenterology, Tokyo Dental College, Ichikawa General Hospital, Ichikawa, Chiba, Japan.
authors.forename: Shogo
authors.initials: S
authors.lastname: Kaida
authors.affiliation: Department of Internal Medicine, Division of Gastroenterology and Hepatology, Keio University, Shinjyuku-ku, Tokyo, Japan.
authors.forename: Takanori
authors.initials: T
authors.lastname: Kanai
authors.affiliation: Department of Internal Medicine, Division of Gastroenterology and Hepatology, Keio University, Shinjyuku-ku, Tokyo, Japan.
authors.forename: Soichiro
authors.initials: S
authors.lastname: Miura
authors.affiliation: Department of Gastroenterology, Tokyo Dental College, Ichikawa General Hospital, Ichikawa, Chiba, Japan.
authors.forename: Jiro
authors.initials: J
authors.lastname: Nishida
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005750:Gastric Juice / Q000378:metabolism*; D006551:Hernia, Hiatal / Q000209:etiology* / Q000378:metabolism; D006801:Humans; D008297:Male; D008875:Middle Aged; D055815:Young Adult