title: Hiatus hernia and intrathoracic migration of esophagogastric junction in gastroesophageal reflux disease.
abstract: The prevalence and clinical presentation of reducible and irreducible hiatus hernia were investigated within a gastro-esophageal reflux disease patient population. Reflux symptoms and esophagitis data were collected on 791 patients. The barium swallow was used to assess the esophagogastric junction. Clinical and endoscopic findings were tested to predict radiographic findings. The esophagogastric junction was normal in 17% of patients, 53% had a sliding hiatus hernia with a reducible esophagogastric junction; in 23% it was irreducible although axial, and 8% had massive incarcerated hiatus hernia. The presence of reducible sliding hiatus hernia did not influence clinical presentation. Axial irreducibility presented with long-standing severe symptoms and esophagitis in 80% of cases. Clinical and endoscopic findings predicted axial irreducibility in 52% of cases. In conclusion, sliding hiatus hernia with an reducible esophagogastric junction does not influence the severity of gastroesophageal reflux disease. An irreducible esophagogastric junction is associated with long-standing severe gastroesophageal reflux disease. Clinical and endoscopic findings may only be indicative of axial esophagogastric junction irreducibility; thus barium swallow should be part of the work-up.
authors.affiliation: Center for the Study and Therapy of Diseases of the Esophagus, Department of Surgery, Intensive Care, and Organ Transplantation, University of Bologna, Bologna, Italy.
authors.forename: Sandro
authors.initials: S
authors.lastname: Mattioli
authors.forename: Franco
authors.initials: F
authors.lastname: D'Ovidio
authors.forename: Vladimiro
authors.initials: V
authors.lastname: Pilotti
authors.forename: Massimo P
authors.initials: MP
authors.lastname: Di Simone
authors.forename: Maria L
authors.initials: ML
authors.lastname: Lugaresi
authors.forename: Francesco
authors.initials: F
authors.lastname: Bassi
authors.forename: Stefano
authors.initials: S
authors.lastname: Brusori
mesh_terms: D004943:Esophagogastric Junction / Q000503:physiopathology*; D005764:Gastroesophageal Reflux / Q000503:physiopathology* / Q000601:surgery; D006551:Hernia, Hiatal / Q000503:physiopathology* / Q000601:surgery; D006801:Humans; D016015:Logistic Models; D016017:Odds Ratio; D012189:Retrospective Studies