Background: Nocturnal reflux has been associated with severe
complications of gastro-oesophageal reflux disease and a poorer quality
of life. Hiatal hernia predisposes to increased oesophageal acid
exposure, but the effect on night reflux symptoms has never been
investigated. The aim of the study was to investigate if hiatal hernia
is associated with more frequent and severe night reflux symptoms.
Methods: A total of 215 consecutive patients (110 male, mean age 52.6
+/- 14.7 years) answered a detailed questionnaire on frequency and
severity of specific day and night reflux symptoms. Subsequently, all
patients underwent upper endoscopy and were categorized in two groups
based on the endoscopic presence of hiatal hernia.
Results: Patients with hiatal hernia were more likely to have nocturnal
symptoms compared to those without hiatal hernia (78.6 vs. 51.8%, p =
0.0001); 59.2% of patients with hiatal hernia reported heartburn and
60.2% regurgitation compared to 43.8 and 39.3% of those without hiatal
hernia, respectively (p = 0.033 and p = 0.003). The proportions of
patients with day heartburn or regurgitation were not significantly
different between the two groups. Night heartburn and regurgitation were
graded as significantly more severe by patients with hiatal hernia (4.9
+/- 4.2 vs. 3.2 +/- 3.7, p +/- 0.002, and 3.8 +/- 4.2 vs. 2.2 +/- 3.5, p
= 0.001, respectively). Patients with hiatal hernia had more frequent
weekly night heartburn and regurgitation compared to those without
hiatal hernia (p = 0.004 and p = 0.008, respectively).
Conclusions: More patients with hiatal hernia reported nocturnal reflux
symptoms compared to those without hiatal hernia. Furthermore, nocturnal
reflux symptoms were significantly more frequent and graded as
significantly more severe in patients with presence of hiatal hernia
rather than in those without hiatal hernia
