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Obesity Surgery

, Volume 20, Issue 6, pp 702–708 | Cite as

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

  • Fernando FornariEmail author
  • Richard Ricachenevsky Gurski
  • Daniel Navarini
  • Victor Thiesen
  • Luis Henrique Barbosa Mestriner
  • Carlos Augusto Scussel Madalosso
Clinical Research

Abstract

Background

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).

Methods

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.

Results

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).

Conclusions

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.

Keywords

Morbid obesity Gastroesophageal reflux disease Hiatal hernia Endoscopy X-rays 

Notes

Conflict of Interest

None.

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Copyright information

© Springer Science + Business Media, LLC 2009

Authors and Affiliations

  • Fernando Fornari
    • 1
    • 2
    • 3
    Email author
  • Richard Ricachenevsky Gurski
    • 4
  • Daniel Navarini
    • 1
    • 4
  • Victor Thiesen
    • 4
  • Luis Henrique Barbosa Mestriner
    • 2
  • Carlos Augusto Scussel Madalosso
    • 1
    • 2
    • 4
  1. 1.GASTROBESEPasso FundoBrazil
  2. 2.Hospital de Ensino São Vicente de PauloPasso FundoBrazil
  3. 3.Faculdade de MedicinaUniversidade de Passo FundoPasso FundoBrazil
  4. 4.Programa de Pós-Graduação em CirurgiaUFRGSPorto AlegreBrazil

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