Ultrasonographic signs of sliding, gastric, and hiatal hernia: their prospective evaluation.

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.