Clinical significance of hiatus hernia on Barrett's oesophagus: a scoping review.

BACKGROUND

Hiatal hernia (HH) is commonly observed in patients with Barrett’s oesophagus (BO), a premalignant condition that may progress to oesophageal adenocarcinoma (OAC). While HH has been implicated in BO pathogenesis, it is not formally recognised as a major risk factor in leading international clinical guidelines. This systematic scoping review aimed to evaluate the role of HH in the development, progression, and treatment outcomes of BO.

METHODS

A systematic scoping review was conducted, searching through databases (PubMed, Medline, Embase, Scopus).

RESULTS

A total of sixty-six articles were included with majority comprised of observational studies. HH was strongly associated with BO development, particularly in cases with larger hernia size (> 2–4 cm) and long-segment BO. While inconsistent, there could BO a trend towards dysplastic and malignant progression of BO in HH. HH may impair the efficacy of radiofrequency ablation, with larger hernias requiring more treatment sessions.

CONCLUSION

Current evidence supports HH as a significant risk factor for BO onset. Its role in progression and management warrants further investigation. Surgical repair may be beneficial in selected asymptomatic patients, especially those with hernias ≥ 4 cm and established BO, to restore the gastro-oesophageal anatomy and eliminate reflux-prone micro-environment.