Surgical Endoscopy

, Volume 27, Issue 12, pp 4590–4595 | Cite as

Endoscopic grading of the gastroesophageal flap valve is correlated with reflux activity and can predict the size of the esophageal hiatus in patients with gastroesophageal reflux disease

  • Oliver Owen Koch
  • Georg Spaun
  • Stavros A. Antoniou
  • Charlotte Rabl
  • Gernot Köhler
  • Klaus Emmanuel
  • Dietmar Öfner
  • Rudolph Pointner



Endoscopic grading of the gastroesophageal flap valve (GEFV) is simple, reproducible, and suggested to be a good predictor of reflux activity. This study aimed to investigate the potential correlation between grading of the GEFV and quality of life (QoL), gastroesophageal reflux disease (GERD) symptoms, esophageal manometry, multichannel intraluminal impedance monitoring (MII) data, and size of the hiatal defect.


The study included 43 patients with documented chronic GERD who underwent upper gastrointestinal endoscopy, esophageal manometry, and ambulatory MII monitoring before laparoscopic fundoplication. The GEFV was graded 1–4 using Hill’s classification. QoL was evaluated using the Gastrointestinal Quality-of-Life Index (GIQLI), and gastrointestinal symptoms were documented using a standardized questionnaire. The size of the esophageal hiatus was measured during surgery by calculating the hiatal surface area (HSA). Analysis of the correlation between QoL, GERD symptoms, esophageal manometry, MII data, HSA size, and GEFV grading was performed. Statistical significance was set at a p value of 0.05.


A significant positive correlation was found between increased GEFV grade and DeMeester score, total number of acid reflux events, number of reflux events in the supine position, and number of reflux events in the upright position. Additionally, a significant positive correlation was found between HSA size and GEFV grading. No significant influence from intensity of GERD symptoms, QoL, and the GEFV grading was found. The mean LES pressures were reduced with increased GEFV grade, but not significantly.


The GEFV plays a major role in the pathophysiology of GERD. The results underscore the importance of reconstructing a valve in patients with GERD and an altered geometry of the gastroesophageal junction when they receive a laparoscopic or endoscopic intervention.


Gastroesophageal flap valve GERD Quality of life Reflux activity 



Oliver Owen Koch, Georg Spaun, Stavros A. Antoniou, Charlotte Rabl, Gernot Köhler, Klaus Emmanuel, Dietmar Öfner, and Rudolph Pointner have no conflicts of interest or financial ties to disclose.


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Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Oliver Owen Koch
    • 1
    • 2
    • 3
  • Georg Spaun
    • 1
  • Stavros A. Antoniou
    • 3
  • Charlotte Rabl
    • 2
  • Gernot Köhler
    • 1
  • Klaus Emmanuel
    • 1
  • Dietmar Öfner
    • 2
  • Rudolph Pointner
    • 3
  1. 1.Department of General and Visceral SurgerySisters of Charity HospitalLinzAustria
  2. 2.Department of SurgeryParacelsus Private Medical UniversitySalzburgAustria
  3. 3.Department of General SurgeryGeneral Hospital Zell am SeeZell am SeeAustria

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