Preoperative diagnosis of hiatal hernia: barium swallow X-ray, high-resolution manometry, or endoscopy?

Michael Weitzendorfer,Lisa Manzenreiter,Stavros A Antoniou,Gernot Köhler,Philipp Schredl,Oliver Owen Koch,Klaus Emmanuel,Leo Pallwein-Prettner

doi:10.1007/s10353-017-0492-y

Abstract

SummaryBackgroundThe assessment of hiatal hernias (HH) is typically done with barium swallow X‑ray, upper endoscopy, and by high-resolution esophageal manometry (HRM). The aim of this study was to assess the clinical utility of these methods in terms of HH detection and their correlation to gastroesophageal reflux disease (GERD).MethodsA retrospective comparative analysis of patients with symptoms of GERD was carried out. The performance of endoscopy and HRM in diagnosing HH was assessed, taking barium swallow X‑ray as a reference. Furthermore, statistically comparative analysis between detected hernias and the presence of reflux disease in ambulatory impedance-pH monitoring (MII) was performed.ResultsOverall, 112 patients were analyzed. Barium swallow X‑ray showed no correlation either to HR manometrically or to endoscopically assessed HH. Significant accordance in the detection rate of HH was proved between HRM and gastroesophagoscopy (p < 0.001). Only endoscopically assessed HH showed a significant correlation with GERD (p = 0.047). No correlation between detected hernias and GERD could be found either with HRM or with barium swallow X‑ray.ConclusionsBarium swallow X‑ray provided the highest rate of HH detection (76.8%). For the reliable exclusion of HH prior to treatment, all three mentioned investigations appear to be necessary in order of low conformity.

Highlights

Hiatus hernia (HH) is recognized as an important factor in the pathophysiology of gastroesophageal reflux disease (GERD)
With high-resolution manometry (HRM), HH was diagnosed in 35 patients (31.25%) with a mean size of 30.51 mm, with radiology 86 patients (76.78%) showed a hernia with a mean size of 32.98 mm
In 54 patients (48.2%), an abnormal gastroesophageal flap valve (GEFV)/HH was diagnosed with upper endoscopy

Summary

Introduction

Hiatus hernia (HH) is recognized as an important factor in the pathophysiology of gastroesophageal reflux disease (GERD). HH develop in 10%–50% of the general population and can be classified into four types: Type I is the sliding hernia which is most common and accounts for 85% of cases It is defined as cephalad migration of the esophagogastric junction through the esophageal hiatus [3, 4]. Sliding HH can be characterized at endoscopy, when the diaphragmatic indentation is seen 2 cm or more distal to the squamocolumnar junction (the so-called Z-line) and the top of the stomach mucosal folds [5, 9, 10] Another approach is to assess the appearance of the esophagogastric junction from a retroflexed position and to incorporate an assessment of hiatal integrity along with the assessment of axial displacement. The aim of this study was to assess the clinical utility of barium swallow X-ray, endoscopic abnormal flap valve and HH assessment, and HRM in the diagnosis of sliding HH in patients with GERD symptoms. Since the presence of HH is associated with GERD, we were interested to discover whether there are differences in objective GERD detected by ambulatory multichannel intraluminal impedance-pH monitoring (MII) and the HH diagnosed using the other investigations

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