Endoscopic measurement of hiatal hernias: is it reliable and does it have a clinical impact? Results from a large prospective database.

IF 2.6 4区 医学 Q1 MEDICINE, GENERAL & INTERNAL
Charles Christian Adarkwah, Oliver Hirsch, Merlissa Menzel, Joachim Labenz
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Abstract

Objectives: The aim of our study was to compare the results of endoscopy and manometry with regard to the presence and longitudinal size of hiatal hernias using a cohort of patients with PPI-refractory reflux symptoms. In addition, we aimed to investigate the clinical relevance of hiatal hernias and their size in relation to the occurrence of GERD.

Methods: Five hundred patients with suspected GERD due to typical reflux symptoms (heartburn and regurgitation) and inadequate response to PPI therapy underwent standardized screening at a reflux center. After 2 weeks of PPI withdrawal, all patients underwent endoscopy, 24-h pH impedance measurement, and high-resolution manometry (HRM). Both endoscopy and HRM results were available for 487 patients.

Results: There was a high correlation between the endoscopic and manometric measured longitudinal size of hernias (rho = .768 (p < .001)). Absolute differences differ on a small effect basis (Cohen's d = 0.23). The presence of hernias increases significantly with the severity of GERD, regardless of whether the hernia was diagnosed by endoscopy or manometry.

Conclusion: In summary, endoscopically and manometrically measured hiatal hernia size are highly significantly correlated. Patients with refractory reflux symptoms and a hernia size of 4 cm are very likely to have GERD. In the future, this finding could greatly simplify the diagnosis of GERD.

内镜下测量裂孔疝:可靠吗?有临床影响吗?来自大型前瞻性数据库的结果。
目的:我们研究的目的是比较内窥镜检查和测压术在有ppi难治性反流症状的患者中关于裂孔疝存在和纵向大小的结果。此外,我们旨在探讨裂孔疝的临床意义及其大小与胃食管反流发生的关系。方法:500例因典型反流症状(胃灼热和反流)和对PPI治疗反应不足而疑似胃食管反流的患者在反流中心进行了标准化筛查。停用PPI 2周后,所有患者接受内窥镜检查、24小时pH阻抗测量和高分辨率测压(HRM)。487例患者均可获得内窥镜检查和HRM结果。结果:内窥镜测得的疝纵向尺寸与测得的疝纵向尺寸高度相关(rho = .768)结论:综上所述,内镜和压力测量的裂孔疝大小高度显著相关。有难治性反流症状和疝气大小为4cm的患者很可能有反流。在未来,这一发现可以大大简化反流性胃炎的诊断。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Postgraduate Medicine
Postgraduate Medicine 医学-医学:内科
CiteScore
6.10
自引率
2.40%
发文量
110
审稿时长
6-12 weeks
期刊介绍: Postgraduate Medicine is a rapid peer-reviewed medical journal published for physicians. Tracing its roots back to 1916,  Postgraduate Medicine  was established by Charles Mayo, MD, as a peer-to-peer method of communicating the latest research to aid physicians when making treatment decisions, and it maintains that aim to this day. In addition to its core subscriber base, Postgraduate Medicine is distributed to hundreds of US-based physicians within internal medicine and family practice.
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