Relationship between posterior pharyngeal pouch and hiatus hernia.

The formation of posterior pharyngeal pouches is generally attributed to dysfunction of the cricopharyngeal sphincter. The reason for this dysfunction and its exact nature have not been established. Observations in the Royal Victoria Hospital, Belfast, suggested that an association exists between pharyngeal pouch and hiatus hernia. Barium studies performed in patients with a pharyngeal pouch using a described technique demonstrated the presence of a hiatus hernia in 32 out of 34 patients. Illustrative case histories and a review of published work on cricopharyngeal function are provided to support our conclusions that gastro-oesophageal reflux is the primary factor leading to cricopharyngeal dysfunction, with the formation of a pharyngeal pouch in some cases. Several possible criticisms of this theory are discussed and the need for further investigation in patients with a pharyngeal pouch is emphasized. The management of patients with a pharyngeal pouch and hiatus hernia is briefly outlined.