Endoscopic signs of gastroesophageal reflux disease with different hiatal hernias types





gastroesophageal reflux disease, hiatal hernia, endoscopy digestive system


A hiatal hernia occurs in 83–94 % of patients with gastroesophageal reflux disease (GERD). Difficulties in diagnosing endoscopic signs of gastroesophageal reflux with combination of the most common hiatal hernia types remain relevant. Untimely and inaccurate endoscopic interpretation of these pathological changes significantly reduces the effectiveness of treatment.

The aim of the research was to study the endoscopic signs of gastroesophageal reflux disease with the most common hiatal hernia type I and type III.

Materials and methods. The examination results of 153 patients with GERD and the most common hiatal hernia type I and type III at the stage of preparation for antireflux surgical treatment were analyzed. The age was 54.5 ± 11.3, there were 48 (31.4 %) men, 105 (68.6 %) women. In Group I – 85 patients with GERD and type I hiatal hernia, in Group II – 68 patients with GERD and type III hiatal hernia. A complete preoperative examination necessarily included endoscopy with chromoendoscopy (mainly NBI or FICE), biopsy from suspicious foci of the gastric mucosa and the lower third of the esophagus followed by histological analysis. Statistical processing and mathematical analysis of the obtained results were performed using the Statistica for Windows 13 (StatSoft Inc., No. JPZ804I382130ARCN10-J). For comparative analysis the arithmetic mean and standard deviation were calculated and presented as M ± s. Differences between groups were assessed using the sub-module “Difference tests” in the module “Basic statistics and tables”. Differences at P < 0.05 were considered statistically significant.

Results. In both groups, non-erosive forms of gastroesophageal reflux disease prevailed: 57 (67.1 %) and 39 (57.4 %) patients respectively. Both in Groups I and II, among the erosive forms there were mainly LA A stages of esophagitis – 20 (23.5 %) and 17 (25.0 %). СLE signs of the esophageal mucosa prevailed in Group I – 16 (18.8 %) patients, in Group II – 5 (7.4 %) patients. The proximal edges of the gastric folds, which are visualized in all patients, were considered the reference point for the true esophageal-gastric junction. Complicated course of GERD was noted in both groups of patients.

Conclusions. Endoscopic signs of GERD with hiatal hernia type I or type III have characteristic features, the severity of which manifestation does not depend on the type. A reliable indicator of the true esophageal-gastric junction location is the proximal edge of the gastric folds. Complicated course of GERD occurs in both groups: Barrett’s esophagus and Schatzki’s ring predominate in the Group I, strictures and ulcers of the esophagus – in the Group II.

Author Biographies

A. O. Nykonenko, Zaporizhzhia State Medical University, Ukraine

MD, PhD, DSc, Professor, Head of the Department of Hospital Surgery

Ye. I. Haidarzhi, Zaporizhzhia State Medical University, Ukraine

MD, PhD, DSc, Associate Professor of the Department of Hospital Surgery

О. М. Kiosov, Zaporizhzhia State Medical University, Ukraine

MD, Assistant of the Department of Faculty Surgery


Dent, J., El-Serag, H. B., Wallander, M. A., & Johansson, S. (2005). Epidemiology of gastro-oesophageal reflux disease: a systematic review. Gut, 54(5), 710-717. https://doi.org/10.1136/gut.2004.051821

Schoppmann, S. F., & Riegler, M. (Eds.). (2021). Multidisciplinary Management of Gastroesophageal Reflux Disease. Springer, Cham. http://doi.org/10.1007/978-3-030-53751-7

Fomin, P. D., Grubnik, V. V., Nikishaev, V. I., & Malinovskii, A. V. (2008). Neopukholevye zabolevaniya pishchevoda [Non-neoplastic diseases of the esophagus]. Kyiv: Biznes-Intellekt. [in Russian].

Shaheen, N. J., Weinberg, D. S., Denberg, T. D., Chou, R., Qaseem, A., Shekelle, P., & Clinical Guidelines Committee of the American College of Physicians (2012). Upper endoscopy for gastroesophageal reflux disease: best practice advice from the clinical guidelines committee of the American College of Physicians. Annals of internal medicine, 157(11), 808-816. https://doi.org/10.7326/0003-4819-157-11-201212040-00008

Ashraf, Memon Muhammed (Ed.). (2018). Hiatal Hernia Surgery. An Evidence Based Approach. Springer International Publishing AG. https://doi.org/10.1007/978-3-319-64003-7

Tutuian R. (2006). Update in the diagnosis of gastroesophageal reflux disease. Journal of gastrointestinal and liver diseases : JGLD, 15(3), 243-247.

McKinley, S. K., Dirks, R. C., Walsh, D., Hollands, C., Arthur, L. E., Rodriguez, N., Jhang, J., Abou-Setta, A., Pryor, A., Stefanidis, D., & Slater, B. J. (2021). Surgical treatment of GERD: systematic review and meta-analysis. Surgical endoscopy, 35(8), 4095-4123. https://doi.org/10.1007/s00464-021-08358-5

Mamazza, J., Schlachta, C. M., & Poulin, E. C. (1998). Surgery for peptic strictures. Gastrointestinal endoscopy clinics of North America, 8(2), 399-413.

ASGE Standards of Practice Committee, Evans, J. A., Early, D. S., Chandraskhara, V., Chathadi, K. V., Fanelli, R. D., Fisher, D. A., Foley, K. Q., Hwang, J. H., Jue, T. L., Pasha, S. F., Sharaf, R., Shergill, A. K., Dominitz, J. A., Cash, B. D., & American Society for Gastrointestinal Endoscopy (2013). The role of endoscopy in the assessment and treatment of esophageal cancer. Gastrointestinal endoscopy, 77(3), 328-334. https://doi.org/10.1016/j.gie.2012.10.001

Milind, R., & Attwood, S. E. (2012). Natural history of Barrett's esophagus. World journal of gastroenterology, 18(27), 3483-3491. https://doi.org/10.3748/wjg.v18.i27.3483

Genta, R. M., Spechler, S. J., & Kielhorn, A. F. (2011). The Los Angeles and Savary-Miller systems for grading esophagitis: utilization and correlation with histology. Diseases of the esophagus, 24(1), 10-17. https://doi.org/10.1111/j.1442-2050.2010.01092.x

Horgan, S., & Fuchs, K.-H. (2020). Management of Gastroesophageal Reflux Disease. Surgical and Therapeutic Innovations. Springer Nature Switzerland AG. http://doi.org/10.1007/978-3-030-48009-7

Eusebi, L. H., Cirota, G. G., Zagari, R. M., & Ford, A. C. (2021). Global prevalence of Barrett's oesophagus and oesophageal cancer in individuals with gastro-oesophageal reflux: a systematic review and meta-analysis. Gut, 70(3), 456-463. https://doi.org/10.1136/gutjnl-2020-321365

Zagari, R. M., Fuccio, L., Wallander, M. A., Johansson, S., Fiocca, R., Casanova, S., Farahmand, B. Y., Winchester, C. C., Roda, E., & Bazzoli, F. (2008). Gastro-oesophageal reflux symptoms, oesophagitis and Barrett's oesophagus in the general population: the Loiano-Monghidoro study. Gut, 57(10), 1354-1359. https://doi.org/10.1136/gut.2007.145177

Hvid-Jensen, F., Pedersen, L., Drewes, A. M., Sørensen, H. T., & Funch-Jensen, P. (2011). Incidence of adenocarcinoma among patients with Barrett's esophagus. The New England journal of medicine, 365(15), 1375-1383. https://doi.org/10.1056/NEJMoa1103042

Fadeenko, G. D., & Gridnev, A. E. (2014). Gastroezofagealnaia refliuksnaia bolezn: pishchevodnye i vnepishchevodnye proiavleniia i komorbidnost [Gastroesophageal reflux disease: esophageal, extraesophageal manifestations and comorbidity]. Kiev: Biblioteka "Zdorov'e Ukrainy". [in Russian].

Grubnik, V. V., & Malinovsky, A. V. (2015) Kriticheskie aspekty laparoskopicheskoi chirurgii gastroezofageal'noy reflyuksnoy bolezni i gryzh pishchevodnogo otverstiya diafragmy [Critical aspects of laparoscopic surgery for gastroesophageal reflux disease and hiatal hernia: monograph]. Odessa: VMV-typography. [in Russian].

Swanstrom, L. L., & Dunst, C. M (Eds.) (2015). Antireflux Surgery. Springer-Verlag New York. http://doi.org/10.1007/978-1-4939-1749-5

Fuchs, K. H., Lee, A. M., Breithaupt, W., Varga, G., Babic, B., & Horgan, S. (2021). Pathophysiology of gastroesophageal reflux disease - which factors are important? Translational gastroenterology and hepatology, 6, 53. https://doi.org/10.21037/tgh.2020.02.12

Aye, R. W., & Hunter, J. G. (Eds.). (2016). Fundoplication Surgery. Springer International Publishing. http://doi.org/10.1007/978-3-319-25094-6

Slater, B. J., Dirks, R. C., McKinley, S. K., Ansari, M. T., Kohn, G. P., Thosani, N., Qumseya, B., Billmeier, S., Daly, S., Crawford, C., P Ehlers, A., Hollands, C., Palazzo, F., Rodriguez, N., Train, A., Wassenaar, E., Walsh, D., Pryor, A. D., & Stefanidis, D. (2021). SAGES guidelines for the surgical treatment of gastroesophageal reflux (GERD). Surgical endoscopy, 35(9), 4903-4917. https://doi.org/10.1007/s00464-021-08625-5




How to Cite

Nykonenko AO, Haidarzhi YI, Kiosov ОМ. Endoscopic signs of gastroesophageal reflux disease with different hiatal hernias types. Pathologia [Internet]. 2022Apr.15 [cited 2024Apr.16];19(1):58-64. Available from: http://pat.zsmu.edu.ua/article/view/252191



Original research