Dong Hongyi, Du Xing, Zhao Jin, Liu Diangang, Du Haijun
Department of General Surgery, Xuanwu Hospital Affiliated to Capital Medical University, 45 Changchun Street, Xicheng District, Beijing, 100053, China.
Department of General Surgery, Beijing Daxing District People's Hospital, Beijing, 102600, China.
Surg Endosc. 2025 May 13. doi: 10.1007/s00464-025-11753-x.
The existing literature has demonstrated that variables such as gender, body mass index (BMI), and age play a significant role in the risk assessment of hiatal hernia. This study aims to comprehensively investigate the association between these risk factors and hiatal hernia through a retrospective analysis and Mendelian randomization (MR) analysis.
In this study, the examination results and basic information of 685 patients who underwent routine esophagogastroduodenoscopy (EGD) at the gastroesophageal Reflux Center of Xuanwu Hospital from 2018 to 2024 were retrospectively collected. logistic regression was used to analyze the potential risk factors. Meanwhile, a two-sample MR analysis was used to further validate and supplement these risk factors.
A retrospective study showed that the incidence of hiatal hernia diagnosed by endoscopy was 28.7%, in the population without GERD, the incidence was 22.8%In the multivariate logistic regression analysis, male sex (P = 0.033), age (P < 0.001), heavy physical labor (P < 0.001), and gastroesophageal reflux disease (GERD) (P < 0.001) were independent risk factors for hiatal hernia, while an increase in BMI, smoking, alcohol consumption, and the number of pregnancies and deliveries in women were not statistically significant. The inverse variance weighting (IVW) results of the MR analysis showed that an increased waist-hip ratio (OR = 2.57, CI 1.32-5.01, P = 0.0057), trunk fat (OR = 3.53, CI 1.76-7.07, P = 0.0004), smoke initiation (OR = 1.47, CI 1.02-2.13, P = 0.0408), and alcohol intake frequency (OR = 2.23, CI 1.18-4.20, P = 0.0134) were associated with hiatal hernia, but the causal relationship between alcohol intake frequency and hiatal hernia was not established.
This study showed that male gender, age, heavy physical labor, and GERD were independent risk factors for hiatal hernia. MR analysis showed that abdominal obesity and smoking may be genetically associated with hiatal hernia. However, there was no statistical significance between increased BMI and hiatal hernia in multivariate analysis and MR analysis.
现有文献表明，性别、体重指数（BMI）和年龄等变量在食管裂孔疝的风险评估中起着重要作用。本研究旨在通过回顾性分析和孟德尔随机化（MR）分析全面探究这些风险因素与食管裂孔疝之间的关联。
在本研究中，回顾性收集了2018年至2024年在宣武医院胃食管反流中心接受常规食管胃十二指肠镜检查（EGD）的685例患者的检查结果和基本信息。采用逻辑回归分析潜在风险因素。同时，使用两样本MR分析进一步验证和补充这些风险因素。
一项回顾性研究显示，内镜诊断的食管裂孔疝发病率为28.7%，在无胃食管反流病（GERD）的人群中，发病率为22.8%。在多因素逻辑回归分析中，男性（P = 0.033）、年龄（P < 0.001）、重体力劳动（P < 0.001）和胃食管反流病（GERD）（P < 0.001）是食管裂孔疝的独立危险因素，而BMI增加、吸烟、饮酒以及女性的妊娠和分娩次数无统计学意义。MR分析的逆方差加权（IVW）结果显示，腰臀比增加（OR = 2.57，CI 1.32 - 5.01，P = 0.0057）、躯干脂肪（OR = 3.53，CI 1.76 - 7.07，P = 0.0004）、开始吸烟（OR = 1.47，CI 1.02 - 2.13，P = 0.0408）和饮酒频率（OR = 2.23，CI 1.18 - 4.20，P = 0.0134）与食管裂孔疝有关，但饮酒频率与食管裂孔疝之间的因果关系未确立。
本研究表明，男性、年龄、重体力劳动和GERD是食管裂孔疝的独立危险因素。MR分析显示，腹部肥胖和吸烟可能与食管裂孔疝存在遗传关联。然而，在多因素分析和MR分析中，BMI增加与食管裂孔疝之间无统计学意义。
