The natural history of the partial thoracic stomach (HIATUS HERNIA) in children

Abstract

A review is described from which has been determined the natural history of the partial thoracic stomach in children. Evidence is also presented indicating that changes in symptomatology on weaning to solid food provide a useful guide to a patient's future progress. It is concluded that about 60-65% of all clinically affected and untreated children pursue a relatively benign clinical course, the majority being free of symptoms by 2 years of age. With but few exceptions, these children show improvement either before or coincident with weaning on to solid food. Symptoms in a further 35% are not improved by weaning on to a mixed diet. Most of these patients suffer from troublesome symptoms up to 4 years of age and longer. A few of these latter children, representing about 5% of all patients, develop an oesophageal stricture. It has been estimated that in the absence of an oesophageal stricture less than 5% of all untreated patients would die. It is suggested that neglect of the study of the natural history has been largely responsible for the differing views expressed on prognosis and on the need for and value of particular forms of treatment. By critically evaluating published information in relation to the knowledge gained from this study it has been possible to explain how the divergent opinions expressed have come to be formulated.