Clinical Utility of Endoscopy and Barium Swallow X-Ray in the Diagnosis of Sliding Hiatal Hernia in Morbidly Obese Patients: A Study Before and After Gastric Bypass
The main clinical consequence of sliding hiatal hernia (SHH) is gastroesophageal reflux disease (GERD). Endoscopy and barium swallow X-ray are commonly used to diagnose SHH. We aimed to assess the clinical utility of endoscopy and X-ray in the diagnosis of SHH in morbidly obese patients before and after gastric bypass (GBP).
Ninety-two patients underwent reflux symptoms evaluation, upper gastrointestinal endoscopy, and barium swallow X-ray before and 6 months after banded GBP. The performance of endoscopy in diagnosing SHH was assessed, taking X-ray as reference. Endoscopy and X-ray were tested as predictors of SHH with GERD.
SHH was more prevalent when characterized by X-ray than endoscopy either before (33% vs. 17%; P = 0.017) or after GBP (26% vs. 7%; P = 0.001). Endoscopy showed low sensitivity (≤40%) and high specificity (≥94%) in diagnosing SHH. Before GBP, more patients with SHH had GERD compared to patients without SHH using either X-ray (83% vs. 58%; P = 0.016) or endoscopy (94% vs. 61%; P = 0.009). After GBP, only patients with radiologic evidence of SHH showed higher prevalence of GERD compared to patients without SHH (50% vs. 26%; P = 0.037). SHH patients also reported weekly or daily vomit more often than patients without SHH (59% vs. 32%; P = 0.026).
In morbidly obese patients, X-ray is superior to endoscopy in diagnosing SHH either before or after banded GBP. In patients treated with this technique, the utilization of X-ray may help in the management of reflux symptoms and frequent vomit.
KeywordsMorbid obesity Gastroesophageal reflux disease Hiatal hernia Endoscopy X-rays
Conflict of Interest
- 2.Zhu H, Pace F, Trapè E, et al. Prevalence of hiatal hernia and its influence of gastro-oesophageal reflux. Eur J Gastroenterol Hepatol. 1994;6:393–7.Google Scholar
- 7.Fornari F, Fucilini LM, Risson C, et al. Contribution of standard oesophageal manometry in sliding hiatal hernia: From the gastro-oesophageal pressure gradient to the diagnosis. Dig Liver Dis 2009; doi: 10.1016/j.dld.2009.04.012.
- 14.Fisichella PM, Patti MG. Gastroesophageal reflux disease and morbid obesity: Is there a relation? World J Surg 2009; doi: 10.1007/s00268-009-0045-z.