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- Title
Endoscopic diagnosis of hiatus hernia under deep inspiration is not consistent with esophageal manometric diagnosis.
- Authors
Hanada, Yuriko; Hoshino, Shintaro; Hoshikawa, Yoshimasa; Takenouchi, Nana; Umezawa, Mariko; Kawami, Noriyuki; Iwakiri, Katsuhiko
- Abstract
<bold>Background: </bold>To investigate the relationship between endoscopic and esophageal manometric hiatus hernia (HH).<bold>Methods: </bold>Forty-six gastroesophageal reflux disease patients with endoscopic HH under maintenance therapy were recruited. Endoscopy was performed on all patients in a fully conscious state. Endoscopic HH was defined as apparent separation greater than 1 cm of the lower margin of the esophageal palisade vessels and the diaphragm hiatus on endoscopy under deep inspiration. Esophageal manometry was conducted using high-resolution manometry (HRM). The length between the lower margin of the lower esophageal sphincter and pulmonary inversion point was measured 10 times. The mean and maximum of the length was then calculated.<bold>Results: </bold>The mean HH length on HRM was 0 cm (0-0) [median (25th to 75th percentile)], 0 cm (0-0), 0.5 cm (0-1.1), and 2.2 cm (1.3-2.5) in the groups with endoscopic HH lengths of 1-2, 2-3, 3-4, and 4-5 cm, respectively. The maximum HH length on HRM was 0 cm (0-0), 0 cm (0-0), 0.8 cm (0-1.4), and 2.4 cm (1.5-2.9) in the 1-2, 2-3, 3-4, and 4-5 cm endoscopic HH groups, respectively. The mean and maximum HH lengths increased significantly in the group with an endoscopic HH length of 4-5 cm compared with the other groups, but did not differ significantly among the 1-2, 2-3, and 3-4 cm groups. Of patients with endoscopic HH less than 3 cm, few had esophageal manometric HH greater than 2 cm.<bold>Conclusions: </bold>Endoscopic diagnosis of HH under deep inspiration is not consistent with esophageal manometric diagnosis, leading to overdiagnosis.
- Subjects
HIATAL hernia; GASTROESOPHAGEAL reflux; ENDOSCOPIC surgery; PULMONARY artery; EOSINOPHILIC esophagitis; DISEASES; COMPARATIVE studies; ESOPHAGUS; ESOPHAGUS diseases; HERNIA; MANOMETERS; RESEARCH methodology; MEDICAL cooperation; RESEARCH; RESEARCH evaluation; RESPIRATION; EVALUATION research; ENDOSCOPIC gastrointestinal surgery; DISEASE complications
- Publication
Journal of Gastroenterology, 2018, Vol 53, Issue 6, p712
- ISSN
0944-1174
- Publication type
journal article
- DOI
10.1007/s00535-017-1403-5