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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

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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 (≤40%) and high specificity (≥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.

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Authors and Affiliations

  1. GASTROBESE, Rua Uruguai, 1555, 1° andar, 99010112, Passo Fundo, Rio Grande do Sul, Brazil

    Fernando Fornari, Daniel Navarini & Carlos Augusto Scussel Madalosso

  2. Hospital de Ensino São Vicente de Paulo, Passo Fundo, Brazil

    Fernando Fornari, Luis Henrique Barbosa Mestriner & Carlos Augusto Scussel Madalosso

  3. Faculdade de Medicina, Universidade de Passo Fundo, Passo Fundo, Brazil

    Fernando Fornari

  4. Programa de Pós-Graduação em Cirurgia, UFRGS, Porto Alegre, RS, Brazil

    Richard Ricachenevsky Gurski, Daniel Navarini, Victor Thiesen & Carlos Augusto Scussel Madalosso

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  1. Fernando Fornari
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  2. Richard Ricachenevsky Gurski
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  3. Daniel Navarini
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  5. Luis Henrique Barbosa Mestriner
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  6. Carlos Augusto Scussel Madalosso
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Correspondence to Fernando Fornari.

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Fornari, F., Gurski, R.R., Navarini, D. et al. 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. OBES SURG 20, 702–708 (2010). https://doi.org/10.1007/s11695-009-9971-y

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