Journal of Ultrasound in Medicine, Vol 13, Issue 9 665-669, Copyright © 1994 by American Institute of Ultrasound in Medicine
Ultrasonographic signs of sliding, gastric, and hiatal hernia: their prospective evaluation
A. Aliotta, G. L. Rapaccini, M. Pompili, A. Grattagliano, A. Cedrone, C. Trombino, F. de Luca and I. de Vitis
Istituto de Clinica Medica, Universita Cattolica del Sacro Cuore, Rome, Italy.
This study was conducted to identify the sonographic findings that might be
used to diagnose sliding gastric hiatal hernia. We first performed a
retrospective evaluation of 12 patients known to have sliding hiatal hernia
and 18 normal controls. In the controls the esophagogastric junction could
be visualized clearly in all cases and the alimentary tract cross section
at the diaphragmatic hiatus ranged from 7.1 to 10.0 mm. The esophagogastric
junction was not visualized in any of the hernia patients, whose alimentary
tract diameters measurements ranged from 16.0 to 21.0 mm. These two markers
(non visualization of the function and diameter greater than 16 mm) were
then evaluated for their ability to predict the occurrence of sliding
hiatas hernia in a prospective study of 38 patients subsequently diagnosed
by means of barium studies and endoscopy. In this group, each sign had a
positive predictive value of 100%. The negative predictive value of the
alimentary tract diameter was 90%; that of non-visualization of the
esophagogastric junction was 94.7%. Inclusion of ultrasonography in the
initial work-up of patients with symptoms of gastroesophageal reflux may
reduce the need for more invasive diagnostic procedures.
