Clinical Gastroenterology Journal

Endoscopy and Histopathological Findings of Gastric Fundus mucosa in patients with Hiatus Hernias

Abstract

Twaha Muwanga, Francis Basimbe*, Ignatius Kakande and Emmanuel Othieno

Background: Hiatal hernia remains a serious medical concern, which occurs quite frequently in the general population, and is characterized by a wide range of non-specific symptoms. Many studies have highlighted the association of hiatus hernia with changes in the distal oesophageal mucosa. Despite the burden of hiatus hernia, little is known about the endoscopic and histopathological changes in the gastric fundus mucosa in patients presenting with this condition and it is known that malignancies involving the fundus and cardia carry a worse prognosis.

Objective: To assess the endoscopic and histopathological findings of gastric fundus mucosa in patients diagnosed with Hiatus hernias at Endoscopy.

Methods: A cross-sectional descriptive study of 120 patients diagnosed with hiatus hernia at St. Francis hospital, Nsambya, Kampala was conducted from 1st August 2022 to 28th February 2023. Diagnosis of hiatus hernia at Gastrointestinal Endoscopy and a hill classification of hiatus hernia was documented. Biopsies were taken from the herniating part of the gastric fundus for histopathological assessment. Data on demographics, medical history, endoscopy and histopathological findings were collected using a pre-tested questionnaire. Data were analyzed using STATA version 16.0.

Results: Among the 120 patients diagnosed with hiatus hernia, 55% were male. The mean age was 42 ± 15.9 years.72% had H. pylori infection. On endoscopy, 5 (4.2%) had normal endoscopy findings, 109 (95%) mucosal hyperemia, 43 (37%) ulcerations; 13 (11%) incarceration. Neither had gangrene nor tumors. None of the patients had normal histopathological findings: 11 (9%) atrophic (chronic) gastritis, 103 (86%) non-atrophic gastritis, 24 (20%) Gastric intestinal metaplasia.

Conclusion: Majority of patients diagnosed with hiatus hernia had abnormal gastric fundus endoscopy findings, and of concern were the 29% of patients that had Atrophic Gastritis and Gastric intestinal metaplasia that are both premalignant lesions.