Hiatal hernia, esophageal achalasia: quality of life and trigger factors for development in war conditions

Background. The esophagogastric junction has a complex anatomical and functional mechanism whose failure is accompanied by the development of hiatal hernia (HН) or esophageal achalasia (EA) requiring surgical correction. Today, in wartime conditions, assessing the quality of life (QOL) and identifying factors contributing to the development of HН and EA are relevant issues in gastroenterology. The aim of the study: to investigate QOL and the impact of trigger factors on the development of HH and EA in war conditions based on questionnaire data. Materials and methods. In the digestive system surgery department, 90 patients were examined between January 2023 and December 2024, of whom 66 were diagnosed with HH and 24 had EA. The control group consisted of 20 healthy individuals. Among the examined patients with HH, there were 49 (74.2 %) men and 17 (25.8 %) women. EA group included 17 (70.8 %) men and 7 (29.2 %) women. The average patients’ age was (47.13 ± 2.81) years. Thirty-nine (43.3 %) patients were military. The general SF-36 questionnaire was used to assess QOL. To study the impact of possible trigger factors on the development of HH and EA, we developed a questionnaire taking into account war factors. Results. It was found that QOL is significantly reduced (p < 0.05) in patients with HH and EA, regardless of status (military serviceman or ordinary citi­zen). Assessment of QOL in the examined patients revealed that the indicators of physical and mental components were lower than those in controls, by 1.6 (p < 0.05) times for both groups. In HH, the indicator of the physical component of health was 1.4 (p < 0.05) times lower than in EA, and the indicator of the mental component of health was 1.7 (p < 0.05) times lower in EA than in HH. When questioned, patients identified possible trigger factors: prolonged and unusually heavy physical exertion (59.1 %) for the development of HH (χ2 = 15.27; p < 0.001) and prolonged stress factor (45.8 %) for the possible development of EA (χ2 = 41.04; p = 0.044). Conclusions. According to the assessment of the QOL in the examined patients during wartime conditions, it was found that the indicator of physical health component was lower in HH than in EA, and the indicator of mental health component was lower in EA than in HH. It was determined that in wartime conditions, the trigger factors contributing to the development of HH were prolonged and unusually heavy physical exertion, and EA might be provoked by an unusual, prolonged stress factor.