BACKGROUND: Endoscopic grading of the gastroesophageal flap valve (GEFV) is simple, reproducible, and suggested to be a good predictor of reflux activity. This study aimed to investigate the potential correlation between grading of the GEFV and quality of life (QoL), gastroesophageal reflux disease (GERD) symptoms, esophageal manometry, multichannel intraluminal impedance monitoring (MII) data, and size of the hiatal defect. METHODS: The study included 43 patients with documented chronic GERD who underwent upper gastrointestinal endoscopy, esophageal manometry, and ambulatory MII monitoring before laparoscopic fundoplication. The GEFV was graded 1-4 using Hill's classification. QoL was evaluated using the Gastrointestinal Quality-of-Life Index (GIQLI), and gastrointestinal symptoms were documented using a standardized questionnaire. The size of the esophageal hiatus was measured during surgery by calculating the hiatal surface area (HSA). Analysis of the correlation between QoL, GERD symptoms, esophageal manometry, MII data, HSA size, and GEFV grading was performed. Statistical significance was set at a p value of 0.05. RESULTS: A significant positive correlation was found between increased GEFV grade and DeMeester score, total number of acid reflux events, number of reflux events in the supine position, and number of reflux events in the upright position. Additionally, a significant positive correlation was found between HSA size and GEFV grading. No significant influence from intensity of GERD symptoms, QoL, and the GEFV grading was found. The mean LES pressures were reduced with increased GEFV grade, but not significantly. CONCLUSIONS: The GEFV plays a major role in the pathophysiology of GERD. The results underscore the importance of reconstructing a valve in patients with GERD and an altered geometry of the gastroesophageal junction when they receive a laparoscopic or endoscopic intervention.
BACKGROUND: Endoscopic grading of the gastroesophageal flap valve (GEFV) is simple, reproducible, and suggested to be a good predictor of reflux activity. This study aimed to investigate the potential correlation between grading of the GEFV and quality of life (QoL), gastroesophageal reflux disease (GERD) symptoms, esophageal manometry, multichannel intraluminal impedance monitoring (MII) data, and size of the hiatal defect. METHODS: The study included 43 patients with documented chronic GERD who underwent upper gastrointestinal endoscopy, esophageal manometry, and ambulatory MII monitoring before laparoscopic fundoplication. The GEFV was graded 1-4 using Hill's classification. QoL was evaluated using the Gastrointestinal Quality-of-Life Index (GIQLI), and gastrointestinal symptoms were documented using a standardized questionnaire. The size of the esophageal hiatus was measured during surgery by calculating the hiatal surface area (HSA). Analysis of the correlation between QoL, GERD symptoms, esophageal manometry, MII data, HSA size, and GEFV grading was performed. Statistical significance was set at a p value of 0.05. RESULTS: A significant positive correlation was found between increased GEFV grade and DeMeester score, total number of acid reflux events, number of reflux events in the supine position, and number of reflux events in the upright position. Additionally, a significant positive correlation was found between HSA size and GEFV grading. No significant influence from intensity of GERD symptoms, QoL, and the GEFV grading was found. The mean LES pressures were reduced with increased GEFV grade, but not significantly. CONCLUSIONS: The GEFV plays a major role in the pathophysiology of GERD. The results underscore the importance of reconstructing a valve in patients with GERD and an altered geometry of the gastroesophageal junction when they receive a laparoscopic or endoscopic intervention.
Authors: Frank Zerbib; Sabine Roman; Alain Ropert; Stanislas Bruley des Varannes; Philippe Pouderoux; Ulriikka Chaput; François Mion; Eric Vérin; Jean-Paul Galmiche; Daniel Sifrim Journal: Am J Gastroenterol Date: 2006-07-18 Impact factor: 10.864
Authors: Oliver O Koch; Adolf Kaindlstorfer; Stavros A Antoniou; Ruzica Rosalia Luketina; Klaus Emmanuel; Rudolph Pointner Journal: Surg Endosc Date: 2013-01-30 Impact factor: 4.584
Authors: Giuseppe Galloro; Mario Musella; Saverio Siciliano; Giovanna Berardi; Antonio Vitiello; Nunzio Velotti; Fernando Rizzello; Paolo Gionchetti; Carlo Calabrese Journal: Endosc Int Open Date: 2022-02-15
Authors: Ida Hansdotter; Ove Björ; Anna Andreasson; Lars Agreus; Per Hellström; Anna Forsberg; Nicholas J Talley; Michael Vieth; Bengt Wallner Journal: Endosc Int Open Date: 2016-02-10
Authors: Hye Kyung Jeon; Gwang Ha Kim; Nam Kyung Lee; Suk Kim; Bong Eun Lee; Geun Am Song Journal: Korean J Intern Med Date: 2016-12-12 Impact factor: 2.884
Authors: Michael Weitzendorfer; Gernot Köhler; Stavros A Antoniou; Leo Pallwein-Prettner; Lisa Manzenreiter; Philipp Schredl; Klaus Emmanuel; Oliver Owen Koch Journal: Eur Surg Date: 2017-09-19 Impact factor: 0.953