Is herniosis the single etiology of Saint's triad?

M. Hauer-Jensen, Zoran Bursac, R. C. Read

Research output: Contribution to journalArticle

17 Citations (Scopus)

Abstract

Background: Sixty years ago, Saint's triad (hiatus hernia, diverticulosis of the colon, and gallbladder disease) was first described in three patients. Since then, the association of these conditions has been questioned. We tested the hypothesis that these conditions are associated, and, based on recent research, propose a common etiology. Methods: Data from the U.S. Veterans Integrated Service Network (VISN) 16 Data Warehouse were analyzed. Chi-square tests and calculated odds ratios (ORs) were utilized to describe the magnitude of association, and multivariable logistic regression models were used to determine the variables associated with Saint's triad. Results: Among 637,518 patient records (1996-2005), any hernia was diagnosed among 22,181 (3.5%) patients, hiatus hernia among 1,661 (0.3%), diverticulosis of the colon among 14,375 (2.3%), and gallbladder disease among 5,284 (0.8%). The following associations were observed: diverticulosis, hiatus hernia (OR: 6.9), hiatus hernia, gallbladder disease (OR = 3.8), and gallbladder disease, diverticulosis (OR = 5.9). Patients with both diverticulosis and gallbladder disease were more likely to have hiatus hernia (OR = 3.8; P = 0.0012) or any hernia (OR = 10.7; P < 0.0001). Diseases associated with Saint's triad (incorporating any hernia) included chronic obstructive pulmonary disease (OR = 4.3), hypertension (OR = 3.1), aortic aneurysm (OR = 2.2), and diabetes (OR = 1.8). Conclusions: Herniosis, the systemic connective tissue disease known to cause diverticulosis and herniae, may be responsible for Saint's triad. Diabetes, like aging, enhanced herniosis. Further research on the gallbladder wall pathology in patients with cholelithiasis or cholecystitis is needed.

Original languageEnglish (US)
Pages (from-to)29-34
Number of pages6
JournalHernia
Volume13
Issue number1
DOIs
StatePublished - Jan 1 2009

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Odds Ratio
Diverticulum
Gallbladder Diseases
Hiatal Hernia
Hernia
Colon
Logistic Models
Cholecystitis
Connective Tissue Diseases
Cholelithiasis
Aortic Aneurysm
Veterans
Chi-Square Distribution
Gallbladder
Research
Chronic Obstructive Pulmonary Disease
Pathology
Hypertension

All Science Journal Classification (ASJC) codes

  • Surgery

Cite this

Is herniosis the single etiology of Saint's triad? / Hauer-Jensen, M.; Bursac, Zoran; Read, R. C.

In: Hernia, Vol. 13, No. 1, 01.01.2009, p. 29-34.

Research output: Contribution to journalArticle

Hauer-Jensen, M. ; Bursac, Zoran ; Read, R. C. / Is herniosis the single etiology of Saint's triad?. In: Hernia. 2009 ; Vol. 13, No. 1. pp. 29-34.
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abstract = "Background: Sixty years ago, Saint's triad (hiatus hernia, diverticulosis of the colon, and gallbladder disease) was first described in three patients. Since then, the association of these conditions has been questioned. We tested the hypothesis that these conditions are associated, and, based on recent research, propose a common etiology. Methods: Data from the U.S. Veterans Integrated Service Network (VISN) 16 Data Warehouse were analyzed. Chi-square tests and calculated odds ratios (ORs) were utilized to describe the magnitude of association, and multivariable logistic regression models were used to determine the variables associated with Saint's triad. Results: Among 637,518 patient records (1996-2005), any hernia was diagnosed among 22,181 (3.5{\%}) patients, hiatus hernia among 1,661 (0.3{\%}), diverticulosis of the colon among 14,375 (2.3{\%}), and gallbladder disease among 5,284 (0.8{\%}). The following associations were observed: diverticulosis, hiatus hernia (OR: 6.9), hiatus hernia, gallbladder disease (OR = 3.8), and gallbladder disease, diverticulosis (OR = 5.9). Patients with both diverticulosis and gallbladder disease were more likely to have hiatus hernia (OR = 3.8; P = 0.0012) or any hernia (OR = 10.7; P < 0.0001). Diseases associated with Saint's triad (incorporating any hernia) included chronic obstructive pulmonary disease (OR = 4.3), hypertension (OR = 3.1), aortic aneurysm (OR = 2.2), and diabetes (OR = 1.8). Conclusions: Herniosis, the systemic connective tissue disease known to cause diverticulosis and herniae, may be responsible for Saint's triad. Diabetes, like aging, enhanced herniosis. Further research on the gallbladder wall pathology in patients with cholelithiasis or cholecystitis is needed.",
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AB - Background: Sixty years ago, Saint's triad (hiatus hernia, diverticulosis of the colon, and gallbladder disease) was first described in three patients. Since then, the association of these conditions has been questioned. We tested the hypothesis that these conditions are associated, and, based on recent research, propose a common etiology. Methods: Data from the U.S. Veterans Integrated Service Network (VISN) 16 Data Warehouse were analyzed. Chi-square tests and calculated odds ratios (ORs) were utilized to describe the magnitude of association, and multivariable logistic regression models were used to determine the variables associated with Saint's triad. Results: Among 637,518 patient records (1996-2005), any hernia was diagnosed among 22,181 (3.5%) patients, hiatus hernia among 1,661 (0.3%), diverticulosis of the colon among 14,375 (2.3%), and gallbladder disease among 5,284 (0.8%). The following associations were observed: diverticulosis, hiatus hernia (OR: 6.9), hiatus hernia, gallbladder disease (OR = 3.8), and gallbladder disease, diverticulosis (OR = 5.9). Patients with both diverticulosis and gallbladder disease were more likely to have hiatus hernia (OR = 3.8; P = 0.0012) or any hernia (OR = 10.7; P < 0.0001). Diseases associated with Saint's triad (incorporating any hernia) included chronic obstructive pulmonary disease (OR = 4.3), hypertension (OR = 3.1), aortic aneurysm (OR = 2.2), and diabetes (OR = 1.8). Conclusions: Herniosis, the systemic connective tissue disease known to cause diverticulosis and herniae, may be responsible for Saint's triad. Diabetes, like aging, enhanced herniosis. Further research on the gallbladder wall pathology in patients with cholelithiasis or cholecystitis is needed.

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