J Neurogastroenterol Motil  https://doi.org/10.5056/jnm22151
Achalasia and Hiatal Hernia: A Rare Association and a Therapeutic Challenge
Georgiana Tutuian,1 Chloé Leandri,1 Radu Tutuian,2,3 Sophie Scialom,1 Mahaut Leconte,4 Anthony Dohan,5 Romain Coriat,1,6 Stanislas Chaussade,1,6 and Maximilien Barret1,6*
1Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique - Hôpitaux de Paris, France; 2Department of Gastroenterology and Hepatology, Bürgerspital Solothurn, Switzerland; 3Berne University, Berne, Switzerland; 4Department of Digestive Surgery, Cochin Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France; 5Department of Abdominal and Interventional Imaging, Cochin Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France; and 6Université de Paris Cité, France
Correspondence to: Maximilien Barret, MD
Hôpital Cochin, service de gastro-entérologie et oncologie digestive, 27 Rue du Faubourg, Saint Jacques, 75014 Paris, France
Fax: +33158412836
E-mail: maximilien.barret@aphp.fr
Received: August 28, 2022; Accepted: December 15, 2022; Published online: August 27, 2023
© The Korean Society of Neurogastroenterology and Motility. All rights reserved.

Abstract
Background/Aims
Achalasia and hiatal hernia are rarely associated. The aim of the current study is to explore the clinical and manometric findings in patients with achalasia and hiatal hernia, and to determine if the presence of a hiatal hernia should influence therapeutic management in patients with achalasia.
Methods
This retrospective single center analysis included a group of patients with achalasia and hiatal hernia (study group) and a group of matched patients with achalasia but no hiatal hernia (control group). We recorded demographic, clinical, endoscopic, and manometric parameters and compared initial presentation and treatment outcomes between the groups.
Results
Between 2015 and 2022, achalasia was diagnosed in 294/1513 (19.4%) patients. Concomitant hiatal hernia was identified in 13/294 (4.4%) patients. Compared to patients with achalasia and no hiatal hernia, patients in the study group had lower Eckardt scores at baseline (5.4 ± 2.0 vs 7.8 ± 2.4; P = 0.005) but similar integrated relaxation pressure. Following treatment, patients in the study and control group had similar clinical success and prevalence of gastroesophageal reflux symptoms.
Conclusions
Hiatal hernia is rarely associated with achalasia. The presence of a hiatal hernia should not influence treatment decisions in patients with achalasia.
Keywords: Esophageal achalasia; Gastroesophageal reflux; Hernia, hiatal


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