The Impact of Hiatus Hernia Size on Dysplasia Progression in Patients With Barrett's Esophagus.

Background and Study Aims: Barrett's esophagus (BE) is the only known precursor to esophageal adenocarcinoma, a condition with high morbidity and mortality and rapidly rising incidence in the Western population. Hiatus hernias increase exposure to acid and bile in the esophagus, driving epithelial damage that eventually leads to BE and dysplasia. Evidence is limited regarding the influence of hiatus hernias on dysplasia progression in BE, particularly in the modern era of endoscopy. Patients and Methods: We conducted a retrospective analysis of a prospectively maintained database, including patients undergoing surveillance endoscopy for BE at a single Australian tertiary center from 1999 to 2025. Endoscopic and histological data were recorded from all surveillance endoscopies and stratified according to the presence and size of hiatus hernia. Results: A total of 547 patients with BE were included, of whom 72.8% were male. 46.6% ( Conclusion: Hiatus hernias, particularly those measuring ≥ 3 cm, significantly increase the likelihood of dysplasia progression in BE. Patients with ≥ 3 cm hiatus hernias should be considered high risk when undertaking endoscopic treatment and surveillance. Further research is required to establish the role of antireflux surgery in parallel with resection and eradication therapy.