Sistema Gastrointestinal e Digestivo

Abstrato

Impact of Hiatal Hernia on Pediatric Gastroesophageal Reflux Disease

Au Yeung KJ, Cannon ML, Arkachaisri T, Gillespie S, Karnsakul W

Objectives: To identify the frequency of hiatal hernia (HH) and the impact of HH size in children with gastroesophageal reflux disease (GERD). Methods: Outpatient records were retrospectively reviewed in children ages 0-17 years old, diagnosed clinically with GERD. HH was diagnosed based on an upper gastrointestinal (UGI) series and HH body was characterized as either small (<2 cm) or large (≥2 cm). For patients who underwent an upper endoscopy, presence and severity of esophagitis was diagnosed with esophageal biopsies and correlated with size of HH. Results: There were 155 children diagnosed clinically with GERD who underwent an UGI. HH was diagnosed in 80 (51%) children via UGI (mean age 7.5 y, 32 female, 48 male). Small HH was observed in 60 children (75%; mean age 7 y, 25 female, 35 male) and large HH in 20 (25%; mean age 3.2 y, 7 female, 13 male). Erosive esophagitis was uncommon in children with HH. Abdominal pain, chest pain and heartburn were commonly reported chief complaints in children (age >5yr) with a large HH. Children with large HH were more frequently found to fail medications and require Nissen fundoplication than those with a small HH (p=0.032). Conclusions: Children with GERD had high frequency of HH based on UGI. Children with large HH required significantly more anti-reflux surgery than those with small HH. A larger scale longitudinal prospective study is needed to further investigate the impact of HH on GERD complications and the effects of therapy.