James M Tatum, MD, Evan Alicuben, MD, Nikolai Bildzukewicz, MD, Kulmeet Sandhu, MD, Kameran Samakar, MD, Caitlin Houghton, MD, John L Lipham, MD. Keck School Of Medicine Of The University Of Southern California
Introduction: Multiple testing modalities are commonly performed on patients undergoing preoperative evaluation of gastroesophageal reflux symptoms. While hiatal hernia is classically associated with GERD, the diagnosis is often present on one test and absent on another, making its clinical significance unclear. The objective of this study is to compare inter-test reliability for the diagnosis of hiatal hernia and to analyze how the diagnosis of hiatal hernia is associated with a positive pH test.
Methods and Procedures: Between 2012 and 2013, 148 patients presenting with typical or atypical symptoms of GERD were evaluated with high resolution manometry (HRM), video esophography VEG, esophagogastroduodenoscopy (EGD) and a 24 or 48-hour esophageal pH probe test. Hiatal hernia was defined as <1cm of intrabdominal esophagus on HRM and the presence of >1cm of gastric lumen above the level of the diaphragmatic hiatus on barium VEG as well as on EGD during retroflexion with insufflation. Positive pH study was defined as a DeMeester score of >14.72 on pH probe test. Binary logistic regression was performed for each diagnostic modality comparing those with or without hiatal hernia adjusting for age, sex, and type of pH test generating odds ratios (OR) of having a DeMeester score of >14.72. Cohen’s Kappa tests were run to assess for inter-test agreement.
Results: Hiatal hernia was diagnosed in 119 (80%) patients on HRM, 92 (62%) patients on VEG, and 69 (47%) patients on EGD. A positive pH test was obtained in 91 (61%) patients. The presence of a hiatal hernia on VEG predicted a positive pH study with an OR of 3.13 [95% CI: 1.54-6.38], p<0.01. A hiatal hernia identified on HRM was not predictive of a positive pH test (1.86 [0.79-4.39], p=0.16), nor was it for EGD, (1.52 [0.77-3.03}, p=0.23). Analysis of inter-test agreement showed fair agreement between HRM and VEG (k = 0.24), EGD and VEG (k = 0.27), and slight agreement between HRM and EGD (k = 0.14).
Conclusions: When considering the presence of any hiatal hernia on pre-operative diagnostic testing, only a diagnosis made by VEG was associated with a positive pH study. In this sample, there is slight to fair agreement of the diagnosis of hiatal hernia between tests.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 87405
Program Number: S115
Presentation Session: Residents/Fellows Session
Presentation Type: ResFel
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