Correlation of the Endoscopic Gastroesophageal Flap Valve with Pathologic Reflux
Copyright © 2024 by the American College of Surgeons. Published by Wolters Kluwer Health, Inc. All rights reserved..
BACKGROUND: The Hill classification characterizes the geometry of gastroesophageal junction (GEJ) and Hill grades (HGs) III and IV have a high association with pathologic reflux. This study aimed to understand the utilization of the Hill classification and correlate the prevalence of pathologic reflux across different HGs.
STUDY DESIGN: A retrospective review of 477 patients who underwent upper endoscopy and BRAVO™ pH monitoring between 8/2018 and 10/2021 was performed. These charts were reviewed for endoscopic finding for hiatal hernia and association of HGs with pathologic reflux, defined as an abnormal esophageal acid exposure time (AET) of ≥4.9%.
RESULTS: Of 477 patients, 252 (52.8%) had a HG documented on the endoscopy report. Of the 252 patients, 61 had HG I (24.2%); 100 had HG II (39.7%); 61 had HG III (24.2%); and 30 had HG IV (11.9%). The proportion of patients with abnormal AET increases with increasing HGs (p<0.001): I (39.3%), II (52.5%), III (67.2%), IV (79.3%). The mean overall AET are as follow: HG I (5.5 ± 6.0%), HG II (7.0 ± 5.9%), HG III (10.2 ± 10.3%), and HG IV (9.5 ± 5.5%). The proportion of patients with hiatal hernia was 18.0% for HG I, 28.0% for HG II, 39.3% for HG III, and 80.0% for HG IV.
CONCLUSIONS: Use of the Hill classification in clinical practice is low. There is an association of increasing HGs with increasing proportion of patients with abnormal AET. There is a high proportion of patients within HG I & II with documented pathologic reflux and the presence of a hiatal hernia as observed on endoscopic exam. Our study suggests that endoscopic grading of the GEJ may not adequately differentiate between normal versus abnormal reflux status, particularly for HG I and II.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2024 |
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| Erschienen: |
2024 |
| Enthalten in: |
Zur Gesamtaufnahme - year:2024 |
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| Enthalten in: |
Journal of the American College of Surgeons - (2024) vom: 29. März |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Manasa, Morgan [VerfasserIn] |
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| Anmerkungen: |
Date Revised 29.03.2024 published: Print-Electronic Citation Status Publisher |
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| doi: |
10.1097/XCS.0000000000001088 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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NLM370407709 |
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| 520 | |a Copyright © 2024 by the American College of Surgeons. Published by Wolters Kluwer Health, Inc. All rights reserved. | ||
| 520 | |a BACKGROUND: The Hill classification characterizes the geometry of gastroesophageal junction (GEJ) and Hill grades (HGs) III and IV have a high association with pathologic reflux. This study aimed to understand the utilization of the Hill classification and correlate the prevalence of pathologic reflux across different HGs | ||
| 520 | |a STUDY DESIGN: A retrospective review of 477 patients who underwent upper endoscopy and BRAVO™ pH monitoring between 8/2018 and 10/2021 was performed. These charts were reviewed for endoscopic finding for hiatal hernia and association of HGs with pathologic reflux, defined as an abnormal esophageal acid exposure time (AET) of ≥4.9% | ||
| 520 | |a RESULTS: Of 477 patients, 252 (52.8%) had a HG documented on the endoscopy report. Of the 252 patients, 61 had HG I (24.2%); 100 had HG II (39.7%); 61 had HG III (24.2%); and 30 had HG IV (11.9%). The proportion of patients with abnormal AET increases with increasing HGs (p<0.001): I (39.3%), II (52.5%), III (67.2%), IV (79.3%). The mean overall AET are as follow: HG I (5.5 ± 6.0%), HG II (7.0 ± 5.9%), HG III (10.2 ± 10.3%), and HG IV (9.5 ± 5.5%). The proportion of patients with hiatal hernia was 18.0% for HG I, 28.0% for HG II, 39.3% for HG III, and 80.0% for HG IV | ||
| 520 | |a CONCLUSIONS: Use of the Hill classification in clinical practice is low. There is an association of increasing HGs with increasing proportion of patients with abnormal AET. There is a high proportion of patients within HG I & II with documented pathologic reflux and the presence of a hiatal hernia as observed on endoscopic exam. Our study suggests that endoscopic grading of the GEJ may not adequately differentiate between normal versus abnormal reflux status, particularly for HG I and II | ||
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| 700 | 1 | |a Choi, Alyssa |e verfasserin |4 aut | |
| 700 | 1 | |a Samarasena, Jason |e verfasserin |4 aut | |
| 700 | 1 | |a Chang, Kenneth |e verfasserin |4 aut | |
| 700 | 1 | |a Nguyen, Ninh T |e verfasserin |4 aut | |
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