Contribution of standard oesophageal manometry in sliding hiatal hernia: From the gastro-oesophageal pressure gradient to the diagnosis

ObjectiveWe tested whether gastro-oesophageal pressure gradient is augmented in sliding hiatal hernia and the yield of oesophageal manometry in diagnosing sliding hiatal hernia.MethodsPatients with equivalent body mass index were categorised according to manometry and endoscopy in groups: (1) no sliding hiatal hernia (n = 147); (2) sliding hiatal hernia solely at endoscopy (n = 46); and (3) sliding hiatal hernia at manometry (n = 22). The yield of manometry was assessed taking endoscopy as referential.ResultsGastro-oesophageal pressure gradient was similar between groups both at inspiration (13.3 ± 5.7 mm Hg vs. 13.6 ± 5.4 mm Hg vs. 12.6 ± 4.4 mm Hg; P = 0.874) or expiration (5.1 ± 3.8 mm Hg vs. 5.2 ± 3.6 mm Hg vs. 5.1 ± 3.7 mm Hg; P = 0.767). Group 3 patients were older than those of groups 1 and 2 (59 ± 10 vs. 42 ± 15 vs. 45 ± 13 years; P < 0.001). Sliding hiatal hernia was larger when characterised by manometry than at endoscopy [4 cm (2.25–4.75) vs. 2 cm (2–3); P < 0.001]. Manometry showed sensitivity of 28% (95%CI 19–40%), specificity of 97% (95%CI 93–99%) and positive predictive value of 82% (95%CI 63–92%) in diagnosing sliding hiatal hernia.ConclusionsBy using manometry in patients with equivalent body mass index, sliding hiatal hernia presence and size are related with age rather than gastro-oesophageal pressure gradient. This technique may be clinically useful when positive for sliding hiatal hernia.