Dyspnoea is common in patients with giant paraoesophageal hernia (PEH). Pulmonary aspiration has previously not been recognised as a significant contributory factor. Aspiration pneumonia in association with both GORD and PEH have a high mortality rate. Reflux aspiration has been examined in a consecutive cohort by scintigraphy scanning and symptoms.
The results of reflux aspiration scintigraphy (RASP) and patient symptoms were evaluated in consecutive patients with giant hiatus hernia (PEH) managed in our service between January 2012 to March 2017.
PEH was diagnosed in 96 patients. Preoperative reflux pulmonary scanning was performed in 70. 54 were females (77.1%) and mean age was 68 (range: 49-85). Dyspnoea was the most common symptom (77.1%), and symptomatic history of aspiration occurred in 18 (25.7%). Clinical aspiration was confirmed by RASP in 13 patients. Silent RASP aspiration occurred in 27 patients without clinical symptoms. RASP was negative in 5 patients with clinical symptoms of aspiration. No aspiration by either criteria or was present in 27 patients. Dysphagia was negatively related to aspiration on RASP (p=<0.01) whilst dyspnoea was not (p=0.857).
Gastroesophageal reflux, dyspnoea, and pulmonary aspiration was frequent in the presence of PEH. Subjective aspiration was the most specific and positive predictor of pulmonary aspiration. High levels of pulmonary aspiration support the routine use of fundoplication in repair of PEH.