Hiatal hernia types and their radiological diagnostics in patients with gastroesophageal reflux disease

Abstract

Gastroesophageal reflux disease (GERD) is one of the most common gastrointestinal pathology. In more than 80–90 % of patients, GERD is caused by the presence of hiatal hernia, leading to the failure of the lower esophageal sphincter. Therefore, experts increasingly agree that GERD can be effectively treated surgically in this case with a detailed diagnosis and assessment of hiatal hernia types. One of the most common methods for diagnosing hiatal hernia is radiological. But the results of the data interpretation obtained during preparation for surgical treatment are contradictory. This situation requires work continuation in this direction. The aim of the study was to improve radiological diagnosis and conduct a detailed analysis of the hiatal hernia types in GERD patients. Materials and methods. The examination results of 120 patients with GERD were analyzed. The mean age was 55.1 ± 10.7, there were 34 (28.3 %) men, 73 (71.7 %) women. In all patients, polypositional radiological examination (“Opera T 90cex”, “General Medical Merate S.p.A.”, Italy) of the esophagus, stomach with a water-soluble contrast agent (barium), photographic fixation, video recording and video analysis was performed. An internationally accepted classification was used to assess the hiatal hernia types. All patients were candidates for surgical treatment by laparoscopic cruroraphy and Nissen or Toupet fundoplication. The results of the preoperative examination were specified intraoperatively. Statistical processing of the obtained results was performed using the Statistica for Windows 13.0 software package (StatSoft Inc., USA). Results. In all patients, hiatal hernias were diagnosed. Type I hernias – in 94 (78.3 %) patients, type II hernias – in 3 (2.5 %), type III hernias – in 15 (12.5 %), type IV was detected in 8 (6.7 %) patients. The features of radiological diagnostic of hiatal hernia types were analyzed in detail, and steps to improve it were proposed. The issues of large and giant hernias diagnosis and definition were addressed. All results were illustrated with our own photographic material. A quantitative and qualitative assessment of the obtained results was carried out. Conclusions. The leading role of various hiatal hernia types in the development of GERD has been suggested. Type I hiatal hernia has been presented as the most common among such patients. Detailed X-ray diagnostics with the use of photographic fixation, video recording and video analysis has been shown to be the important and effective method for determining the anatomical features of hiatal hernia types as the main factors of the esophagogastric junction disruption and, consequently, the development of GERD.