title: 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.
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 (<or=40%) and high specificity (>or=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.
authors.affiliation: GASTROBESE, Rua Uruguai, 1555, 99010112, Passo Fundo, Rio Grande do Sul, Brazil. fernandofornari@gmail.com
authors.forename: Fernando
authors.initials: F
authors.lastname: Fornari
authors.forename: Richard Ricachenevsky
authors.initials: RR
authors.lastname: Gurski
authors.forename: Daniel
authors.initials: D
authors.lastname: Navarini
authors.forename: Victor
authors.initials: V
authors.lastname: Thiesen
authors.forename: Luis Henrique Barbosa
authors.initials: LH
authors.lastname: Mestriner
authors.forename: Carlos Augusto Scussel
authors.initials: CA
authors.lastname: Madalosso
mesh_terms: D000328:Adult; D001466:Barium Sulfate; D004311:Double-Blind Method; D005260:Female; D015390:Gastric Bypass / Q000379:methods*; D005773:Gastroscopy / Q000379:methods*; D006551:Hernia, Hiatal / Q000175:diagnosis* / Q000000981:diagnostic imaging; D006801:Humans; D008297:Male; D009767:Obesity, Morbid / Q000601:surgery*; D011446:Prospective Studies; D011859:Radiography; D012680:Sensitivity and Specificity; D020535:Video-Assisted Surgery
chemical_list: D001466:Barium Sulfate