Weijenborg P W, van Hoeij F B, Smout A J P M, Bredenoord A J
Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, The Netherlands.
Neurogastroenterol Motil. 2015 Feb;27(2):293-9. doi: 10.1111/nmo.12507.
The diagnosis of a sliding hiatal hernia is classically made with endoscopy or barium esophagogram. Spatial separation of the lower esophageal sphincter (LES) and diaphragm, the hallmark of hiatal hernia, can also be observed on high-resolution manometry (HRM), but the diagnostic accuracy of this finding has not yet been investigated. To determine the diagnostic value of HRM in the detection of hiatal hernia.
HRM recordings, endoscopy reports, and barium esophagograms of 90 patients were analyzed for the presence and size of a hiatal hernia. The diagnostic value of a hernia specific HRM pressure pattern was calculated, and the agreement of HRM with endoscopy and barium esophagogram for the assessment of hernia size.
HRM was found to be highly sensitive and specific for hiatal hernia detection, with a sensitivity of 92% and specificity of 95%, exceeding the sensitivity of endoscopy or radiography alone (both 73%). Patients with a hiatal hernia on HRM were manometrically characterized by an esophagogastric junction (EGJ) with partial or complete separation of the LES and crural diaphragm (CD), the latter being associated with significantly lower EGJ pressure. A cutoff value of spatial LES-CD separation on HRM of 1.85 cm yielded the optimal performance in identifying hiatal hernia. Agreement between HRM, endoscopy, and radiography for size of hiatal hernias was good (ICC [95% CI] 0.74 [0.65-0.82]).
CONCLUSIONS & INFERENCES: With HRM, the presence or absence and size of a hiatal hernia can be assessed with greater sensitivity than with endoscopy or radiography alone.
滑动性食管裂孔疝的诊断传统上通过内镜检查或食管钡餐造影进行。食管下括约肌（LES）与膈肌的空间分离是食管裂孔疝的标志，在高分辨率测压法（HRM）中也可观察到，但这一发现的诊断准确性尚未得到研究。旨在确定HRM在检测食管裂孔疝中的诊断价值。
分析90例患者的HRM记录、内镜检查报告和食管钡餐造影，以确定食管裂孔疝的存在及大小。计算疝特异性HRM压力模式的诊断价值，并评估HRM与内镜检查和食管钡餐造影在评估疝大小方面的一致性。
发现HRM对食管裂孔疝检测具有高度敏感性和特异性，敏感性为92%，特异性为95%，超过单独内镜检查或影像学检查的敏感性（均为73%）。HRM显示有食管裂孔疝的患者在测压方面的特征为食管胃交界（EGJ）处LES与膈脚（CD）部分或完全分离，后者与EGJ压力显著降低相关。HRM上LES - CD空间分离的截断值为1.85 cm时，在识别食管裂孔疝方面表现最佳。HRM、内镜检查和影像学检查在食管裂孔疝大小方面的一致性良好（组内相关系数[95%可信区间] 0.74 [0.65 - 0.82]）。
使用HRM评估食管裂孔疝的有无及大小，比单独使用内镜检查或影像学检查具有更高的敏感性。
