The prevalence of hiatus hernia can only be estimated, because most of these hernias cause mild or no symptoms and diagnostic criteria may vary. One study used non-contrast computed tomography (CT) to identify hiatal hernias in a large sample of asymptomatic adults (aged 53 to 94 years); they reported a prevalence of 9.9%, but noted CT may be insensitive to small, sliding hernias.[2]Kim J, Hiura GT, Oelsner EC, et al. Hiatal hernia prevalence and natural history on non-contrast CT in the multi-ethnic study of atherosclerosis (MESA). BMJ Open Gastroenterol. 2021 Mar;8(1):e000565.
https://bmjopengastro.bmj.com/content/8/1/e000565
http://www.ncbi.nlm.nih.gov/pubmed/33731384?tool=bestpractice.com
Higher rates are reported among symptomatic populations. In one retrospective study of patients who had undergone endoscopy at a tertiary care hospital, the prevalence of hiatal hernia was 28.9%.[3]Alsahafi MA, Alajhar NA, Almahyawi AO, et al. The prevalence and risk factors for hiatal hernia among patients undergoing endoscopy: a retrospective analysis. Saudi Med J. 2023 May;44(5):509-12.
https://smj.org.sa/content/44/5/509
http://www.ncbi.nlm.nih.gov/pubmed/37182923?tool=bestpractice.com
The prevalence may be lower in Asian-Americans.[2]Kim J, Hiura GT, Oelsner EC, et al. Hiatal hernia prevalence and natural history on non-contrast CT in the multi-ethnic study of atherosclerosis (MESA). BMJ Open Gastroenterol. 2021 Mar;8(1):e000565.
https://bmjopengastro.bmj.com/content/8/1/e000565
http://www.ncbi.nlm.nih.gov/pubmed/33731384?tool=bestpractice.com
The incidence of symptomatic cases of hiatus hernia is closely related to the diagnosis of gastro-oesophageal reflux disease (GORD), as these two conditions are closely (but not completely) correlated.[3]Alsahafi MA, Alajhar NA, Almahyawi AO, et al. The prevalence and risk factors for hiatal hernia among patients undergoing endoscopy: a retrospective analysis. Saudi Med J. 2023 May;44(5):509-12.
https://smj.org.sa/content/44/5/509
http://www.ncbi.nlm.nih.gov/pubmed/37182923?tool=bestpractice.com
[4]Petersen H, Johannessen T, Sandvik AK, et al. Relationship between endoscopic hiatus hernia and gastroesophageal reflux symptoms. Scand J Gastroenterol. 1991 Sep;26(9):921-6.
http://www.ncbi.nlm.nih.gov/pubmed/1947783?tool=bestpractice.com
The precise incidence of treated cases of GORD in large populations is difficult to verify. According to one meta-analysis, the pooled global prevalence of GORD is about 14%, with significant regional variation.[5]Nirwan JS, Hasan SS, Babar ZU, et al. Global prevalence and risk factors of gastro-oesophageal reflux disease (GORD): systematic review with meta-analysis. Sci Rep. 2020 Apr 2;10(1):5814.
https://www.nature.com/articles/s41598-020-62795-1
http://www.ncbi.nlm.nih.gov/pubmed/32242117?tool=bestpractice.com
Among all hiatus hernias, the sliding type (type I) is by far the most common, accounting for 85% to 95% of cases. For para-oesophageal hernias (types II-IV), type III (mixed, para-oesophageal with a sliding component) is the most common.[1]Society of American Gastrointestinal and Endoscopic Surgeons. Guidelines for the management of hiatal hernia. Apr 2013 [internet publication].
http://www.sages.org/publications/guidelines/guidelines-for-the-management-of-hiatal-hernia
[6]Roman S, Kahrilas PJ. The diagnosis and management of hiatus hernia. BMJ. 2014 Oct 23;349:g6154.
http://www.ncbi.nlm.nih.gov/pubmed/25341679?tool=bestpractice.com