title: Hiatal hernia size is the dominant determinant of esophagitis presence and severity in gastroesophageal reflux disease.
abstract: OBJECTIVE
  Although reflux esophagitis is a multifactorial disease, the relative importance of these pathogenetic factors has not been clearly established. In this study, regression analysis was used to model the major determinants of esophagitis in patients with symptomatic gastroesophageal reflux disease (GERD).
  
  
  METHODS
  Sixty-six GERD patients and 16 asymptomatic controls were evaluated. All patients underwent upper endoscopy, esophageal manometry, and 24-h pH monitoring. Esophagrams were performed in 38 of the GERD patients and all controls. Stepwise regression was performed using esophagitis severity as the dependent variable. Logistic regression was performed grouping subjects as controls, nonerosive GERD, or erosive esophagitis.
  
  
  RESULTS
  Hiatal hernia size, lower esophageal sphincter pressure, esophageal acid exposure, and number of reflux episodes >5 min significantly correlated with esophagitis severity. Stepwise regression identified hiatal hernia size (p = 0.0001) and lower esophageal sphincter pressure (p = 0.0024) as significant predictors of esophagitis. Logistic regression also identified hiatal hernia size (chi2 = 17.07, p < 0.0001) and lower esophageal sphincter pressure (chi2 = 5.97, p = 0.0146) as significant predictors of erosive esophagitis.
  
  
  CONCLUSIONS
  Esophagitis severity is best predicted by hiatal hernia size and lower esophageal sphincter pressure. Of these, hiatal hernia size is the strongest predictor.
authors: Division of Gastroenterology, Northwestern University, Chicago, Illinois, USA.
authors: M P
authors: MP
authors: Jones
authors: S S
authors: SS
authors: Sloan
authors: J C
authors: JC
authors: Rabine
authors: C C
authors: CC
authors: Ebert
authors: C F
authors: CF
authors: Huang
authors: P J
authors: PJ
authors: Kahrilas
mesh_terms: D000328:Adult; D016145:Endoscopy, Digestive System; D004942:Esophagitis, Peptic / Q000175:diagnosis / Q000209:etiology / Q000473:pathology*; D004943:Esophagogastric Junction / Q000503:physiopathology; D004947:Esophagus / Q000737:chemistry; D005260:Female; D005764:Gastroesophageal Reflux / Q000150:complications*; D006551:Hernia, Hiatal / Q000209:etiology / Q000473:pathology*; D006801:Humans; D006863:Hydrogen-Ion Concentration; D008297:Male; D008365:Manometry; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors