Clinical Diagnostic Value of Gastroscopy, High-resolution Esophageal Manometry and Upper Gastrointestinal Contrast Examination for Hiatal Hernia in Metabolic Syndrome: a Comparative Analysis

Abstract

Background There is no a gold standard examination method for the diagnosis of hiatal hernia in patients with metabolic syndrome. Improving the preoperative detection rate of hiatal hernia is of great significance for formulating an appropriate surgical approach and avoiding severe postoperative complications. Objective To examine the diagnostic value of gastroscopy, high-resolution esophageal manometry and upper gastrointestinal contrast examination for hiatal hernia in metabolic syndrome. Methods Fifty-five patients with metabolic syndrome complicated with gastroesophageal reflux who were surgically treated in Department of Minimally Invasive, Hernia and Abdominal Surgery, People's Hospital of Xinjiang Uygur Autonomous Region from September 2021 to April 2022 were retrospectively selected, including 17 with hiatal hernia found intraoperatively (complex group) and 38 without (simple group) . The results of gastroscopy, high-resolution esophageal manometry, acid measurement, upper gastrointestinal contrast tests performed after admission and GERD-Q score were collected. Receiver operating characteristic (ROC) curves of these examination methods were plotted and the area under the ROC curve (AUC) was compared for estimating their diagnostic performance. Results Compared with simple group, complex group had higher diagnostic rates of gastroscopy, high-resolution esophageal manometry, greater manometric hiatal hernia diameter and upper gastrointestinal contrast examination, and higher Gerd-Q score (P<0.05) . Complex group also had lower mean resting pressure of lower esophageal sphincter (LESP) and Demeester score (P<0.05) . Multivariate Logistic regression analysis showed that Demeester score and findings upper gastrointestinal angiography were associated with the diagnosis of hiatus hernia in metabolic syndrome (P<0.05) . ROC analysis indicated that all of gastroscopy (AUC=0.728, P=0.007) , LESP (AUC=0.789, P=0.001) , Demeester score (AUC=0.772, P=0.001) , upper gastrointestinal contrast examination (AUC=0.774, P=0.007) , Gerd-Q score (AUC=0.746, P=0.004) had an AUC greater than 0.7, indicating high clinical diagnostic value. Conclusion Gastroscopy, LESP, Demeester score, upper gastrointestinal contrast examination, and Gerd-Q score all had high diagnostic value for hiatus hernia in metabolic syndrome.

Keywords

• metabolic syndrome|hernia, hiatal|upper gastrointestinal contrast examination|gastroscope|high-resolution esophageal manometry|diagnostic value