Detection of hiatal hernias: comparison of high-resolution manometry and physician reported in an obese-predominant population

Abstract

BackgroundThe diagnosis of a hiatal hernia (HH) can be made by barium oesophagram or upper endoscopy. Data regarding the ability of high-resolution manometry (HRM) with oesophageal pressure topography (OPT) to identify HH remains limited. We aim to assess the diagnostic accuracy of the automated localisation on high-resolution manometry compared with physician visual interpretation on the detection of HH.MethodsPatients (n=181) from West Virginia, Pennsylvania, Maryland, Virginia and Ohio, undergoing HRM with OPT from 1 January 2015 to 1 December 2017 were reviewed. The BMIs of this patient population are of the highest in the USA. Demographics, presenting symptoms, laboratory data, endoscopic findings, radiographic findings, and HRM findings were collected. Diagnosis of HH through HRM automated identification of oesophageal landmarks were compared with diagnosis by physician visual interpretation of OPT.ResultsAutomated identification of HH using HRM had high specificity (99.1%), but low sensitivity (11.4%). Physician visual interpretation of OPT similarly had high specificity (82.9%, 83.8%), but low sensitivity (30.0%, 28.6%). Automated identification of HH had a greater positive predictive value (88.9%) compared with physician visual interpretation (52.5%, 52.6%) but was found to have a similar negative predictive value (63.9%) as physician visual interpretation (65.3%, 65.0%).ConclusionCompared with physician visual interpretation of OPT, automated identification of HH was more specific, but less sensitive in the diagnosis of HH. Use of automated identification of HH using HRM alone may lead to an increased number of false negatives, and subsequent underdiagnosis of this condition.

Prevalence of Asymptomatic Hiatal Hernia in Obese Patients During Preoperative Upper Gastrointestinal Endoscopy Assessments and Correlation With Body Mass Index

“…HH is a stomach disorder that involves herniation of the abdominal cavity. In the United States from 2003 to 2006, HH was the primary and secondary cause of hospitalization in 142 of 10,000 inpatients [ 5 ]. However, the exact prevalence of HH is difficult to ascertain owing to the inherent diagnostic criteria.…”

“…According to Hill’s classification, HH is classified based on endoscopic findings into the following: sliding HH, which is the most common type (95% of patients); para-esophageal HH, which is seen when the lower esophageal sphincter remains preserved while the fundus of the stomach herniates through the diaphragm; mixed type; and the fourth type, which involves migration of the stomach or bowel. The common symptoms of this disease include dysphagia, heartburn, regurgitation, nausea/vomiting, chest pain, and abdominal pain [ 4 , 5 ]. There are multiple risk factors associated with HHs, including age, sex, race, body mass index (BMI), or any increase in intra-abdominal pressure [ 1 ].…”

Tubularized and Effaced Gastric Cardia Mimicking Barrett Esophagus Following Sleeve Gastrectomy

“…In sub-study 2.2, HRM was undertaken to accurately delineate the spatial relations of the crural diaphragm and LES in a subset of patients with endoscopic tubularized cardia and histological evidence of gastric mucosa 23–25 (Fig. 3).…”

“…In sub-study 2.2, HRM was undertaken to accurately delineate the spatial relations of the crural diaphragm and LES in a subset of patients with endoscopic tubularized cardia and histological evidence of gastric mucosa [23][24][25] (Figure 3). Manometry was performed with a 16-channel silicone nasogastric manometry catheter (Mui Scientific, Ontario, Canada) with 1 cm side-hole spacing across the region of the GEJ and a water-perfused system.…”