Diagnostic value of <scp>X</scp>‐ray, endoscopy, and high‐resolution manometry for hiatal hernia: A systematic review and meta‐analysis

Li, Lunan; Gao, Huiqin; Zhang, Chenjing; Tu, Jiangfeng; Geng, Xiaoge; Wang, Jingya; Zhou, Xiaolu; Pan, Wensheng; Jing, Jiyong

doi:10.1111/jgh.14758

Cited by 14 publications

(7 citation statements)

References 22 publications

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“…A recent meta-analysis comparing barium swallow, HRM, and endoscopy for preoperative HH diagnosis suggested that manometry exhibited better diagnostic performance and that barium swallow and endoscopy were equivocal. 26 However, it is noted that our endoscopy results fall within the range of the pooled sensitivity of 77% (95% CI 70-83%) and specificity of 92% (95% CI 85-96%) of HRM. This meta-analysis also considered both bariatric and nonbariatric populations and only had a single study of 130 patients from the Asian region.…”

Section: Discussionsupporting

confidence: 51%

Accuracy of hiatal hernia diagnosis in bariatric patients: Preoperative endoscopy versus intraoperative reference

et al. 2020

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Background and Aim Obesity is becoming increasingly prevalent in Asia. Bariatric surgery in the region is growing in popularity to reflect increasing demand. Hiatal hernia (HH) is common among the obese population. There is a lack of evidence comparing preoperative endoscopy against intraoperative findings as a standard of reference for HH diagnosis. Methods This was a retrospective analysis of a bariatric procedure database from a single tertiary teaching hospital and high‐volume endoscopy center. Electronic medical records were reviewed. Endoscopy results were compared to intraoperative findings, and subgroup analysis of >2 cm hernias was performed. Sensitivity, specificity, predictive values, likelihood ratios, and global diagnostic test accuracy were calculated. Results A total of 434 patients were eligible for this study, of which HH was detected in 37 patients (prevalence rate 8.55%). Mean age was 41.51 ± 11.07 years, and body mass index was 39.37 ± 5.67 kg/m 2 . Endoscopy sensitivity was 75.68% (95% confidence interval, 58.80–88.23%) and specificity 91.44% (88.24–94.00%). Positive likelihood ratio was 8.53 (6.11–12.79) and negative likelihood ratio 0.27 (0.15–0.47). Positive predictive value was 45.16% (36.27–54.38%) and negative predictive value 97.58% (95.80–98.62%). Accuracy of endoscopy for preoperative HH diagnosis was 90.09% (86.89–92.74%). Conclusion Endoscopy can have a high diagnostic accuracy of preoperative HH diagnosis in obese Asian patients using intraoperative diagnosis as the reference standard.

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Section: Discussionsupporting

confidence: 51%

Accuracy of hiatal hernia diagnosis in bariatric patients: Preoperative endoscopy versus intraoperative reference

et al. 2020

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“…The abnormal anatomical morphology of the GEJ weakens the anti-reflux function and the low motility state decreases the clearance ability of the esophagus and prolongs acid exposure time, which not only aggravate regurgitation, but also affects the efficacy of PPI treatment ( 6 ). Reflux symptoms can recur or persist in patients with GERD and an abnormal anatomical morphology of the GEJ ( 2 ). In the present study, the anatomical morphology of the GEJ of patients with different severity of regurgitation was analyzed.…”

Section: Discussionmentioning

confidence: 99%

“…Abnormalities of the GEJ, including the severity of the esophageal mucosa injury, axial length of the hiatal hernia (HH), degree of relaxation of the cardia, and morphological changes in the gastroesophageal flap valve (GEFV), can be observed directly through gastroscopy. Reflux symptoms can recur or persist in patients with GERD and an abnormal anatomical morphology of the GEJ ( 2 , 3 ). A previous review showed that 17 to 45% of 21,736 patients still experienced reflux symptoms after treatment with proton-pump inhibitors (PPIs) ( 4 ).…”

Section: Introductionmentioning

confidence: 99%

Predicting reflux symptom recurrence: The impact of gastroesophageal junction indicators and body mass index among outpatients

Wang

Sui

et al. 2023

Exp Ther Med

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The present study aimed to evaluate the efficacy of the prediction model in predicting reflux symptom recurrence among outpatients with reflux esophagitis (RE). A total of 261 outpatients diagnosed with RE complicated by anatomical alterations at the gastroesophageal junction and reflux symptoms were included in the study. Through follow-up, patients were divided into a General group (149 cases) and a Recurrent group (112 cases). Receiver operating characteristic curves of the related factors and prediction model were analyzed to compare the efficacy of each element in predicting reflux recurrence. A prediction model was constructed for predicting reflux recurrence using the axial length of the hiatal hernia (HH), the diameter of the esophageal hiatus, Hill classification, and body mass index (BMI) as risk factors. The cutoff values of the aforementioned factors for predicting reflux recurrence were: an axial length of HH >2 cm, esophageal hiatus diameter ≥3 cm, Hill grade >III, and BMI >25.1 kg/m 2 . The multivariate prediction model constructed using the aforementioned four indicators together with chronic atrophic gastritis and Helicobacter pylori infection had the area under the curve of 0.801 (95% confidence interval: 0.748-0.854), and the cutoff value of 46.8 had a sensitivity and specificity of 71.4% and 75.8%, respectively. The predictive model in the present study can be used for the primary assessment of reflux recurrence in patients with RE.

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“…Spastic disorders including distal esophageal spasm and type III (spastic) achalasia benefit from peroral endoscopic myectomy (POEM) surgery while type I or II achalasia have better outcomes with interventions focused on the LES (pneumatic dilation or Heller's myotomy of the LES) (228)(229)(230)(231). HRM can also diagnose hiatal hernias (232) or evaluate esophageal motility before (233) and after anti-reflux fundoplication surgery (234,235).…”

Section: Indicationsmentioning

confidence: 99%

A Comparative Assessment of the Diagnosis of Swallowing Impairment and Gastroesophageal Reflux in Canines and Humans

et al. 2022

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Swallowing impairment is a highly prevalent and clinically significant problem affecting people and dogs. There are myriad causes of swallowing impairment of which gastroesophageal reflux is the most common in both species. Similarities in anatomy and physiology between humans and canines results in analogous swallowing disorders including cricopharyngeus muscle achalasia, esophageal achalasia, hiatal herniation, and gastroesophageal reflux with secondary esophagitis and esophageal dysmotility. Accordingly, the diagnostic approach to human and canine patients with swallowing impairment is similar. Diagnostic procedures such as swallowing fluoroscopy, high-resolution manometry, pH/impedance monitoring, and endolumenal functional luminal imaging probe can be performed in both species; however, nasofacial conformation, increased esophageal length, and the difficulty of completing several of these procedures in awake dogs are inherent challenges that need to be considered. Human patients can convey their symptoms and respond to verbal cues, whereas veterinarians must rely on clinical histories narrated by pet owners followed by comprehensive physical examination and observation of the animal eating different food consistencies and drinking water. Dogs may also be unwilling to drink or eat in the hospital setting and may be resistant to physical restraint during diagnostic procedures. Despite the species differences and diagnostic challenges, dogs are a natural animal model for many oropharyngeal and esophageal disorders affecting people, which presents a tremendous opportunity for shared learnings. This manuscript reviews the comparative aspects of esophageal anatomy and physiology between humans and canines, summarizes the diagnostic assessment of swallowing impairment in both species, and discusses future considerations for collaborative medicine and translational research.

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Diagnostic value of X‐ray, endoscopy, and high‐resolution manometry for hiatal hernia: A systematic review and meta‐analysis

Cited by 14 publications

References 22 publications

Accuracy of hiatal hernia diagnosis in bariatric patients: Preoperative endoscopy versus intraoperative reference

Accuracy of hiatal hernia diagnosis in bariatric patients: Preoperative endoscopy versus intraoperative reference

Predicting reflux symptom recurrence: The impact of gastroesophageal junction indicators and body mass index among outpatients

A Comparative Assessment of the Diagnosis of Swallowing Impairment and Gastroesophageal Reflux in Canines and Humans

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