Division of Internal Medicine, Department of Medicine, Creighton University, Omaha, NE, USA.
Department of Surgery, Creighton University, School of Medicine, Omaha, NE, USA.
Dig Dis Sci. 2021 Jan;66(1):151-159. doi: 10.1007/s10620-020-06146-0. Epub 2020 Feb 20.
Hill's classification provides a reproducible endoscopic grading system for esophagogastric junction morphology and competence, specifically whether the gastroesophageal flap valve (GEFV) is normal (grade I/II) or abnormal (grades III/IV). However, it is not routinely used in clinical practice. We report a systematic review and meta-analysis to determine association between abnormal GEFV and gastroesophageal reflux disorder (GERD).
A comprehensive literature search of MEDLINE and Scopus databases was conducted to identify studies that reported the association between abnormal GEFV and GERD. The search and quality assessment were performed independently by two authors. Fixed- and random-effects meta-analyses were conducted using symptomatic GERD and erosive esophagitis as outcomes.
A total of 11 studies met inclusion criteria that included a total of 5054 patients. In the general population, patients with abnormal GEFV had greater risk of symptomatic GERD compared to patients with a normal GEFV (risk ratio [RR] 1.88, 95% CI 1.57-2.24). Further, in patients with symptomatic GERD, patients with abnormal GEFV had greater risk of erosive esophagitis compared to patients with normal GEFV (RR 2.17, 95% CI 1.40-3.36). Finally, the specificity of abnormal GEFV for symptomatic GERD was 73.3% (95% CI 69.3-77.0%) and 75.7% (95% CI 65.9-83.4%) for erosive esophagitis in symptomatic GERD.
Our systematic review and meta-analysis showed consistent association between abnormal GEFV indicated by Hill's classification III/IV and symptomatic GERD and erosive esophagitis. Our recommendation is to include Hill's classification in routine endoscopy reports and workup for GERD.
希尔斯分类法为食管胃交界处的形态和功能提供了一种可重复的内镜分级系统，特别是胃食管瓣（GEFV）是否正常（I/II 级）或异常（III/IV 级）。然而，它在临床实践中并未常规使用。我们报告了一项系统评价和荟萃分析，以确定异常 GEFV 与胃食管反流病（GERD）之间的关联。
对 MEDLINE 和 Scopus 数据库进行全面文献检索，以确定报告异常 GEFV 与 GERD 之间关联的研究。搜索和质量评估由两名作者独立进行。使用症状性 GERD 和糜烂性食管炎作为结局进行固定效应和随机效应荟萃分析。
共有 11 项研究符合纳入标准，共纳入 5054 例患者。在一般人群中，与正常 GEFV 相比，异常 GEFV 的患者患症状性 GERD 的风险更高（风险比 [RR] 1.88，95%CI 1.57-2.24）。此外，在有症状性 GERD 的患者中，与正常 GEFV 相比，异常 GEFV 的患者患糜烂性食管炎的风险更高（RR 2.17，95%CI 1.40-3.36）。最后，异常 GEFV 对症状性 GERD 的特异性为 73.3%（95%CI 69.3-77.0%），对症状性 GERD 中糜烂性食管炎的特异性为 75.7%（95%CI 65.9-83.4%）。
我们的系统评价和荟萃分析显示，希尔斯分类法 III/IV 所示的异常 GEFV 与症状性 GERD 和糜烂性食管炎之间存在一致的关联。我们建议在 GERD 的常规内镜报告和检查中纳入希尔斯分类法。
