Endoscopic observations around the gastroesophageal junction in patients with symptomatic gastroesophageal reflux disease in South Asia

Navarathne, Navarathne M. M.; Abeysuriya, V.; Ileperuma, A.; Thoufeek, U. L.

doi:10.1007/s12664-010-0047-7

Cited by 10 publications

(13 citation statements)

References 12 publications

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“…Some previous Asian studies reported that abnormal GEFV was a risk factor of RE, and associated with RE severity in adults as well as in pediatric patients. [2][3][4]7 Our study also confirmed this finding in Vietnamese population. It is well known that the prevalence of RE in Caucasian population is higher than that in Asian population.…”

Section: Discussionsupporting

confidence: 89%

“…The association between GEFV and gastroesophageal reflux disease (GERD) has been already reported in several previous studies. [2][3][4][5][6][7] However, most of these studies were conducted on patients with reflux esophagitis (RE) [2][3][4][5] and there were very few studies on patients with dyspepsia and non-erosive reflux disease (NERD). 6,7 There have been no studies investigating the distribution of abnormal GEFV among patients with dyspepsia, NERD and different grades of RE in the same set of patients.…”

Section: Introductionmentioning

confidence: 99%

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Abnormal Gastroesophageal Flap Valve Is Associated With High Gastresophageal Reflux Disease Questionnaire Score and the Severity of Gastroesophageal Reflux Disease in Vietnamese Patients With Upper Gastrointestinal Symptoms

Quach

Nguyen

Hiyama

2018

J Neurogastroenterol Motil

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Background/AimsThere have been no studies investigating the distribution of abnormal gastroesophageal flap valve (GEFV) among patients with dyspepsia, non-erosive reflux disease (NERD), and reflux esophagitis (RE) in the same set of patients. The aims of this study are to investigate (1) the association between GEFV and gastroesophageal reflux disease questionnaire (GERDQ) score, and (2) the distribution of abnormal GEFV in Vietnamese patients presenting with upper gastrointestinal symptoms.MethodsThree hundred and thirty-one patients recruited in this prospective cross-sectional study were classified into 3 groups: reflux esophagitis (RE), non-erosive reflux disease (NERD) (GERDQ score ≥ 8, no endoscopic mucosal injury), and dyspepsia (GERDQ score < 8, no endoscopic mucosal injury). The GEFV was graded endoscopically according to the Hill classification. GEFV grades I and II were regarded as normal, while grades III and IV were regarded as abnormal GEFV.ResultsThere were 215 (65.0%) patients with dyspepsia, 55 (16.6%) patients with NERD, and 61 (18.4%) patients with RE. Abnormal GEFV was an independent risk factor for GERD (OR, 2.93; CI 95%, 1.76–4.88) and RE (OR, 3.41; CI 95%, 1.78–6.53). The mean GERDQ score of patients with abnormal GEFV was significantly higher than that of patients with normal GEFV (5.7 ± 2.4 vs 4.9 ± 2.7, P = 0.011). The prevalence of abnormal GEFV gradually increased in patients with dyspepsia (27.4%), NERD (43.6%), grade A RE (56.8%), and grades B/C RE (80.0%) (P < 0.001).ConclusionsAbnormal GEFV was significantly associated with high GERDQ score. Its prevalence gradually increased in patients with dyspepsia, NERD, and RE, respectively.

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Section: Discussionsupporting

confidence: 89%

Section: Introductionmentioning

confidence: 99%

Abnormal Gastroesophageal Flap Valve Is Associated With High Gastresophageal Reflux Disease Questionnaire Score and the Severity of Gastroesophageal Reflux Disease in Vietnamese Patients With Upper Gastrointestinal Symptoms

Quach

Nguyen

Hiyama

2018

J Neurogastroenterol Motil

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“…A systematic review found the prevalence of GORD to be 10 -20 percent in the Western world [2]. Community prevalence of GORD in Sri Lanka is not known but a single study done by Nawarathne et al found it closer to 15% [1]. While clinically troublesome heartburn is seen in about 6 percent of the population [3], chest pain may be the sole presenting complaint of GORD [4,5].…”

Section: Epidemiologymentioning

confidence: 99%

“…As such, endoscopy has excellent specificity for the diagnosis of GORD especially when erosive oesophagitis is seen. In a study done on Sri Lankan patients who had symptoms suggestive of GORD, hiatus hernia (HH), columnar lined oesophagus (CLO) and reflux oesophagitis (RO) were found in 14.3%, 9.5% and 13.3% respectively [1]. Based on current literature the use of routine biopsy of the oesophagus to diagnose GORD cannot be recommended in a patient with heart-burn and a normal endoscopy.…”

Section: Establishing the Diagnosis Of Gordmentioning

confidence: 99%

Diagnosis and management of gastro-oesophageal reflux disease

Dinamithra

Nawarathne

2015

Sri Lanka j Surg

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“…Studies have shown an association between higher Hill grades and the frequency of GERD 8 14 . Higher Hill grades are also associated with lower LES pressure 8 , increased prevalence of hiatal hernia 15 , and are able to predict poor response to proton pump inhibitor treatment 16 . The Hill classification has been proven to be reproducible and provides useful information when evaluating patients with suspected GERD who are undergoing endoscopy 8 .…”

Section: Introductionmentioning

confidence: 99%

Hill classification is superior to the axial length of a hiatal hernia for assessment of the mechanical anti-reflux barrier at the gastroesophageal junction

et al. 2016

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Background and study aims: The pathogenesis of gastroesophageal reflux disease (GERD) is multifactorial, including the mechanical anti-reflux barrier of the gastroesophageal junction. This barrier can be evaluated endoscopically in two ways: by measuring the axial length of any hiatal hernia present or by assessing the gastroesophageal flap valve. The endoscopic measurement of axial length is troublesome because of the physiological dynamics in the area. Grading the gastroesophageal flap valve is easier and has proven reproducible. The aim of the present study was to compare the two endoscopic grading methods with regard to associations with GERD. Patients and methods: Population-based subjects underwent endoscopic examination assessing the axial length of hiatus hernia, the gastroesophageal flap valve using the Hill classification, esophagitis using the Los Angeles (LA) classification, and columnar metaplasia using the Z-line appearance (ZAP) classification. Biopsies were taken from the squamocolumnar junction to assess the presence of intestinal metaplasia. Symptoms were recorded with the validated Abdominal Symptom Questionnaire. GERD was defined according to the Montreal definition. Results: In total, 334 subjects were included in the study and underwent endoscopy; 86 subjects suffered from GERD and 211 presented no symptoms or signs of GERD. Based on logistic regression, the estimated area under the curve statistic (AUC) for Hill (0.65 [95 %CI 0.59 – 0.72]) was higher than the corresponding estimate for the axial length of a hiatal hernia (0.61 [95 %CI 0.54 – 0.68]), although the difference was not statistically significant (P = 0.225). Conclusion: From our data, and in terms of association with GERD, the Hill classification was slightly stronger compared to the axial length of a hiatal hernia, but we could not verify that the Hill classification was superior as a predictor. The Hill classification may replace the axial length of a hiatal hernia in the endoscopic assessment of the mechanical anti-reflux barrier of the gastroesophageal junction.

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Endoscopic observations around the gastroesophageal junction in patients with symptomatic gastroesophageal reflux disease in South Asia

Abstract: Substantial proportion of patients with symptoms of GERD has abnormal endoscopic findings around the gastroesophageal junction.

Cited by 10 publications

References 12 publications

Abnormal Gastroesophageal Flap Valve Is Associated With High Gastresophageal Reflux Disease Questionnaire Score and the Severity of Gastroesophageal Reflux Disease in Vietnamese Patients With Upper Gastrointestinal Symptoms

Abnormal Gastroesophageal Flap Valve Is Associated With High Gastresophageal Reflux Disease Questionnaire Score and the Severity of Gastroesophageal Reflux Disease in Vietnamese Patients With Upper Gastrointestinal Symptoms

Diagnosis and management of gastro-oesophageal reflux disease

Hill classification is superior to the axial length of a hiatal hernia for assessment of the mechanical anti-reflux barrier at the gastroesophageal junction

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