title: Analysis of computed tomographic findings according to gastroesophageal flap valve grade.
abstract: The gastroesophageal junction is an important barrier against gastroesophageal ref lux. Endoscopic grading of gastroesophageal f lap valve is simple, reproducible, and may predict reflux activity. We investigated the correlation between gastroesophageal flap valve grade and the gastroesophageal junction's structural properties using abdominal computed tomography.
  
  
  
  A total of 138 patients with early gastric cancer who underwent both pre-treatment esophagogastroduodenoscopy and water-distended stomach two-phase computed tomography were enrolled. Endoscopic gastroesophageal f lap valve grade and abdominal computed tomography findings were analyzed to assess anatomical factors including the gastroesophageal junction and related organs.
  
  
  
  The angle of His increased significantly with gastroesophageal flap valve grade (grade I, 65.2˚ ± 19.6˚; grade II, 66.6˚ ± 19.8˚; grade III, 76.7˚ ± 11.9˚; grade IV, 120.0˚ ± 30.3˚;p< 0.001), as did the size of the diaphragmatic hiatus (grade I, 213.0 ± 53.8 mm2; grade II, 232.6 ± 71.0 mm2; grade III, 292.3 ± 99.2 mm2; grade IV, 584.4 ± 268.3;p< 0.001). The length of the abdominal esophagus decreased as gastroesophageal flap valve grade increased (grade I, 34.6 ± 5.8 mm; grade II, 32.0 ± 6.5 mm; grade III, 24.6 ± 7.8 mm; grade IV, -22.6 ± 38.2 mm;p< 0.001). There was no significant relationship between gastroesophageal flap valve grade and visceral and subcutaneous fat areas (p= 0.877 andp= 0.508, respectively).
  
  
  
  Endoscopic grading of the gastroesophageal flap valve is well correlated with anatomical changes around the gastroesophageal junction on abdominal computed tomography, and it can provide useful information about the anti-reflux barrier.
authors.affiliation: Department of Internal Medicine, Pusan National University School of Medicine, and Biomedical Research Institute, Pusan National University Hospital, Busan, Korea.
authors.forename: Hye Kyung
authors.initials: HK
authors.lastname: Jeon
authors.affiliation: Department of Internal Medicine, Pusan National University School of Medicine, and Biomedical Research Institute, Pusan National University Hospital, Busan, Korea.
authors.forename: Gwang Ha
authors.initials: GH
authors.lastname: Kim
authors.affiliation: Department of Radiology, Pusan National University School of Medicine, and Biomedical Research Institute, Pusan National University Hospital, Busan, Korea.
authors.forename: Nam Kyung
authors.initials: NK
authors.lastname: Lee
authors.affiliation: Department of Radiology, Pusan National University School of Medicine, and Biomedical Research Institute, Pusan National University Hospital, Busan, Korea.
authors.forename: Suk
authors.initials: S
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, Pusan National University School of Medicine, and Biomedical Research Institute, Pusan National University Hospital, Busan, Korea.
authors.forename: Bong Eun
authors.initials: BE
authors.lastname: Lee
authors.affiliation: Department of Internal Medicine, Pusan National University School of Medicine, and Biomedical Research Institute, Pusan National University Hospital, Busan, Korea.
authors.forename: Geun Am
authors.initials: GA
authors.lastname: Song
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004942:Esophagitis, Peptic / Q000000981:diagnostic imaging / Q000209:etiology; D004943:Esophagogastric Junction / Q000033:anatomy & histology / Q000000981:diagnostic imaging*; D005260:Female; D005764:Gastroesophageal Reflux / Q000517:prevention & control; D006801:Humans; D008297:Male; D008875:Middle Aged; D056910:Republic of Korea; D014057:Tomography, X-Ray Computed / Q000379:methods
keywords: Computed tomography; Endoscopy; Gastroesophageal f lap valve; Gastroesophageal ref lux; His angle