title: Sliding gastric hiatal hernia diagnosis by transabdominal ultrasonography: an easy, reliable and non-invasive procedure.
abstract: OBJECTIVE
  Data in the literature suggest the possibility of using ultrasonography to diagnose sliding gastric hiatal hernia. The aim of this study was to confirm the diagnostic accuracy of transabdominal ultrasonography for the diagnosis of sliding gastric hiatal hernia, using endoscopy as the reference test. The latter procedure was used since it also recognizes the presence of esophagitis and/or varices, two pathological conditions that could per se influence ultrasonographic evaluation, based on measurement of the esophageal diameter.
  
  
  METHODS
  A total of 180 consecutive patients, admitted to our hospital for endoscopy, were examined. Of these, 12 patients were not included in the final study. After fasting, the remaining 168 patients were first evaluated by ultrasonography and later by endoscopy. Esophageal diameter was measured by ultrasonography at the level of the diaphragmatic hiatus.
  
  
  RESULTS
  Using a diameter > or = 18 mm as the sensitivity threshold, 29 patients potentially affected by hiatal hernia were identified by ultrasonography. Upper endoscopy examination confirmed the presence of hiatal hernia in 24 of these patients and documented 4 additional hernias in the group of patients with a transdiaphragmatic esophageal diameter <18 mm (positive and negative predictive values were 82.7% and 97%, respectively). Analysis of the distribution of esophageal varices and esophagitis in all 168 excluded the possibility that these pathological conditions could influence the esophageal diameter.
  
  
  CONCLUSIONS
  Ultrasonography represents a simple and well-tolerated diagnostic approach in sliding gastric hiatal hernia. The good diagnostic accuracy suggests its potential use in clinical and epidemiological settings.
authors.affiliation: Section of Gastroenterology, D.E.T.O, University of Bari, Ospedale Policlinico, Piazza Giulio Cesare 11, IT-70124 Bari, Italy. m.barone@gastro.uniba.it
authors.forename: Michele
authors.initials: M
authors.lastname: Barone
authors.forename: Paolo
authors.initials: P
authors.lastname: Di Lernia
authors.forename: Monica
authors.initials: M
authors.lastname: Carbonara
authors.forename: Roberta
authors.initials: R
authors.lastname: Ladisa
authors.forename: Annunziata
authors.initials: A
authors.lastname: Donno
authors.forename: Annacinzia
authors.initials: A
authors.lastname: Amoruso
authors.forename: Alfredo
authors.initials: A
authors.lastname: Di Leo
authors.forename: Antonio
authors.initials: A
authors.lastname: Francavilla
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004947:Esophagus / Q000473:pathology; D005260:Female; D006551:Hernia, Hiatal / Q000175:diagnosis* / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D008875:Middle Aged; D014463:Ultrasonography