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Is there a common basis between hiatal hernia and hemorrhoidal disease?
Medical Hypotheses 84 (2015) 525
Contents lists available at ScienceDirect
Medical Hypotheses journal homepage: www.elsevier.com/locate/mehy
Correspondence
Is there a common basis between hiatal hernia and hemorrhoidal disease? Zeynep Sahiner, Mehmet Uzel, Levent Filik ⇑ Ankara Research Hospital, Gastroenterology Clinic, Ankara, Turkey
a r t i c l e
i n f o
Article history: Received 8 May 2014 Accepted 4 February 2015
a b s t r a c t In this letter-to-editor, we hypothesize that there is a link between hemorrhoidal disease and hiatal hernia. We underline common risk factors for both and present a cross-sectional patient data. Therefore, we emphasize the necessity of new studies to clarify this coincidence. Clinical benefit of establishment of this link is to delay or prevent development of hiatal hernia as a result of appropriate preventive measures. Accordingly, postoperative period of hiatal hernia operations may also be relieved or recurrence risk may also be decreased with this precautions. Ó 2015 Elsevier Ltd. All rights reserved.
Hemorrhoidal disease is a very common health problem affecting up to 40% of the people at least once in life. Although several causal relations to hemorrhoidal disease have been proposed, ã weak veinã is the major reason. On the other hand, abdominal pressure increase due to several reasons among obesity, sitting, coughing, lifting heavy objects, standing or bowel movements are physical stresses leading to development of hemorrhoid [1]. On the other hand, muscle weakness has pivotal role in hiatal hernia development but pathogenesis is still on debate [2]. Both hiatal hernia and hemorrhoidal disease has a pathogenesis based on muscle tissue weakness and intraabdominal pressure increase. Regarding to both hemorrhoid and hiatal hernia we hypothesized if there is a common link in their pathogenesis. To support this hypothesis, we checked the reports of esophagogastroscopy performed simultaneously of consecutive 100 adult patients younger than 40 years with hemorrhoid diagnosed via rectosigmoidoscopy if the patients have also hiatal hernia. Thirteen (13%) of the patients who was diagnosed to have hemorrhoid with rectosigmoidoscopy had also hiatal hernia diagnosed at the same admission incidentally. All the above-mentioned knowledge and the preliminary data supports the hypothesis that hiatal hernia is linked to hemorrhoidal disease. There are some persons in the population that prone to develop hiatal hernia later in life among the patients with hemorrhoids. Because hemorrhoidal disease emerges especially in the second decade and hiatal hernia mostly occurs people over 50 and is seen more than 60% in persons older than 60 years. The
⇑ Corresponding author at: Ankara Research Hospital, Gastroenterology Clinic, Ulucanlar, Altindag 06600, Turkey. Tel.: +90 3125954272. E-mail address: leventfi[email protected] (L. Filik). http://dx.doi.org/10.1016/j.mehy.2015.02.005 0306-9877/Ó 2015 Elsevier Ltd. All rights reserved.
expected frequency of hiatal hernia in ages younger than 40 years is less than 10%. In conclusion, we hypothesize that there is a link between hemorrhoidal disease and hiatal hernia and emphasize the necessity of new studies to clarify this coincidence. Clinical benefit of establishment of this link is to delay or prevent development of hiatal hernia as a result of appropriate preventive measures. Accordingly, postoperative period of hiatal hernia operations may also be relieved or recurrence risk may also be decreased with this precautions. Conflict of interest We all authors declare that there is not any financial and personal relationships with other people or organisations that could inappropriately influence (bias) their work. There is no potential conflicts of interest including employment, consultancies, stock ownership, honoraria, paid expert testimony, patent applications/ registrations, and grants or other funding. We declare that there is no role of sponsors, if any, in the collection, analysis and interpretation of data; in the writing of the manuscript; and in the decision to submit the manuscript for publication. References [1] Madoff RD, Fleshman JW. American gastroenterological association technical review on the diagnosis and treatment of hemorrhoids. Gastroenterology 2004;126:1463–73. [2] Mittal RK. Hiatal hernia. Am J Med 1997;103(5A):33S–9S.
Contents lists available at ScienceDirect
Medical Hypotheses journal homepage: www.elsevier.com/locate/mehy
Correspondence
Is there a common basis between hiatal hernia and hemorrhoidal disease? Zeynep Sahiner, Mehmet Uzel, Levent Filik ⇑ Ankara Research Hospital, Gastroenterology Clinic, Ankara, Turkey
a r t i c l e
i n f o
Article history: Received 8 May 2014 Accepted 4 February 2015
a b s t r a c t In this letter-to-editor, we hypothesize that there is a link between hemorrhoidal disease and hiatal hernia. We underline common risk factors for both and present a cross-sectional patient data. Therefore, we emphasize the necessity of new studies to clarify this coincidence. Clinical benefit of establishment of this link is to delay or prevent development of hiatal hernia as a result of appropriate preventive measures. Accordingly, postoperative period of hiatal hernia operations may also be relieved or recurrence risk may also be decreased with this precautions. Ó 2015 Elsevier Ltd. All rights reserved.
Hemorrhoidal disease is a very common health problem affecting up to 40% of the people at least once in life. Although several causal relations to hemorrhoidal disease have been proposed, ã weak veinã is the major reason. On the other hand, abdominal pressure increase due to several reasons among obesity, sitting, coughing, lifting heavy objects, standing or bowel movements are physical stresses leading to development of hemorrhoid [1]. On the other hand, muscle weakness has pivotal role in hiatal hernia development but pathogenesis is still on debate [2]. Both hiatal hernia and hemorrhoidal disease has a pathogenesis based on muscle tissue weakness and intraabdominal pressure increase. Regarding to both hemorrhoid and hiatal hernia we hypothesized if there is a common link in their pathogenesis. To support this hypothesis, we checked the reports of esophagogastroscopy performed simultaneously of consecutive 100 adult patients younger than 40 years with hemorrhoid diagnosed via rectosigmoidoscopy if the patients have also hiatal hernia. Thirteen (13%) of the patients who was diagnosed to have hemorrhoid with rectosigmoidoscopy had also hiatal hernia diagnosed at the same admission incidentally. All the above-mentioned knowledge and the preliminary data supports the hypothesis that hiatal hernia is linked to hemorrhoidal disease. There are some persons in the population that prone to develop hiatal hernia later in life among the patients with hemorrhoids. Because hemorrhoidal disease emerges especially in the second decade and hiatal hernia mostly occurs people over 50 and is seen more than 60% in persons older than 60 years. The
⇑ Corresponding author at: Ankara Research Hospital, Gastroenterology Clinic, Ulucanlar, Altindag 06600, Turkey. Tel.: +90 3125954272. E-mail address: leventfi[email protected] (L. Filik). http://dx.doi.org/10.1016/j.mehy.2015.02.005 0306-9877/Ó 2015 Elsevier Ltd. All rights reserved.
expected frequency of hiatal hernia in ages younger than 40 years is less than 10%. In conclusion, we hypothesize that there is a link between hemorrhoidal disease and hiatal hernia and emphasize the necessity of new studies to clarify this coincidence. Clinical benefit of establishment of this link is to delay or prevent development of hiatal hernia as a result of appropriate preventive measures. Accordingly, postoperative period of hiatal hernia operations may also be relieved or recurrence risk may also be decreased with this precautions. Conflict of interest We all authors declare that there is not any financial and personal relationships with other people or organisations that could inappropriately influence (bias) their work. There is no potential conflicts of interest including employment, consultancies, stock ownership, honoraria, paid expert testimony, patent applications/ registrations, and grants or other funding. We declare that there is no role of sponsors, if any, in the collection, analysis and interpretation of data; in the writing of the manuscript; and in the decision to submit the manuscript for publication. References [1] Madoff RD, Fleshman JW. American gastroenterological association technical review on the diagnosis and treatment of hemorrhoids. Gastroenterology 2004;126:1463–73. [2] Mittal RK. Hiatal hernia. Am J Med 1997;103(5A):33S–9S.