Endoscopic measurement of cardia circumference as an indicator of GERD.
BACKGROUND
It is theorized that repeated gastric distention leads to dilatation of the cardia and the development of GERD. We hypothesize that cardia circumference correlates with the presence and the severity of GERD, and we developed software to measure cardia circumference from static endoscopic images. Our aims were to validate the software and to quantify cardia circumference along the spectrum of GERD.


METHODS
Software-based measurements were compared with actual measurements in animal and mechanical models. A retrospective review of an endoscopic database and patient charts produced 273 subjects, grouped as follows: controls, GERD, < or = 3-cm Barrett's esophagus, or > 3-cm Barrett's esophagus. A blinded abstractor measured cardia circumference by using images from the database.


RESULTS
Software and actual measurements correlated closely and were reproducible among observers. Median cardia circumference for each group was the following: control, 31.8 mm; GERD, 37.8 mm; < or = 3-cm Barrett's esophagus, 38.4 mm; and > 3-cm Barrett's esophagus, 45.0 mm (p < 0.001). By using 34.3 mm as a cutoff, cardia circumference was 85.3% sensitive and 89.6% specific for the diagnosis of GERD.


CONCLUSIONS
There was a direct relationship between cardia circumference and the presence of GERD. This finding augments our understanding of the anatomic contributions of the esophagogastric junction in the pathogenesis of GERD. Cardia measurement may prove to be a useful diagnostic tool.
Seltman
Ann K
AK
Department of Surgery, Oregon Health and Science University, Portland, Oregon, USA.
Kahrilas
Peter J
PJ
Chang
Eugene Y
EY
Mori
Motomi
M
Hunter
John G
JG
Jobe
Blair A
BA
D000818:Animals; D001471:Barrett Esophagus / Q000473:pathology; D002299:Cardia / Q000033:anatomy & histology*; D016208:Databases, Factual; D016099:Endoscopy, Gastrointestinal; D005260:Female; D005764:Gastroesophageal Reflux / Q000175:diagnosis*; D005773:Gastroscopy; D006801:Humans; D008297:Male; D008962:Models, Theoretical; D015588:Observer Variation; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012984:Software; D013552:Swine