Hill’s Classification of Gastro-Oesophageal Flap Valve weakness: A valuable Tool for Endoscopic Grading of Gastro-Oesophageal Reflux Disease
Main Article Content
Abstract
Introduction: Gastro-Oesophageal Reflux Disease is one of the most common conditions needing an endoscopy evaluation. The evaluation of this condition also needs 24-hour pH-monitoring and oesophageal manometry, but in reality, these investigations are not easily available and are cumbersome.
Methodology: We used the Hill’s classification for the gastro-oesophageal flap valve and objectified the evaluation of the reflux present. We were able to objectively assess the findings during endoscopy mainly the Gastro-Oesophageal Flap Valve using the Hill’s Classification and correlate its grade with the presentation of gastro-oesophageal reflux disease and its possible treatments with outcome.
Inference and conclusion: We find this tool to be easy to perform and interpret as compared to the more cumbersome and complex 24-hour pH monitoring and Oesophageal Manometry. With our study we wish to encourage the use of Hill’s Classification in all endoscopies done for reflux disease.
Word of Caution: Investigations like the 24-hour pH-monitoring and Oesophageal Manometry can be reserved for select cases that may either need further evaluation of this condition or have the need to rule out functional conditions of the oesophagus like the oesophageal motility disorders.
Article Details
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References
2) Osman A, Albashir MM, Nandipati K, Walters RW, Chandra S. Esophagogastric Junction Morphology on Hill's Classification Predicts Gastroesophageal Reflux with Good Accuracy and Consistency. Dig Dis Sci. 2021 Jan;66(1):151-159. doi: 10.1007/s10620-020-06146-0. Epub 2020 Feb 20. PMID: 32078088.
3) Oberg S, Peters JH, DeMeester TR, Lord RV, Johansson J, Crookes PF, Bremner CG. Endoscopic grading of the gastroesophageal valve in patients with symptoms of gastroesophageal reflux disease (GERD). Surg Endosc. 1999 Dec;13(12):1184-8. doi: 10.1007/pl00009617. PMID: 10594262.
4) Koch OO, Spaun G, Antoniou SA, Rabl C, Köhler G, Emmanuel K, Öfner D, Pointner R. Endoscopic grading of the gastroesophageal flap valve is correlated with reflux activity and can predict the size of the oesophageal hiatus in patients with gastroesophageal reflux disease. Surg Endosc. 2013 Dec;27(12):4590-5. doi: 10.1007/s00464-013-3071-8. Epub 2013 Jul 12. PMID: 23846367.
5) Kaplan M, Tanoglu A, Erkul E, Kara M, Yazgan Y. Association of reflux symptom index scores with gastroesophageal flap valve status. Auris Nasus Larynx. 2014 Dec;41(6):543-7. doi: 10.1016/j.anl.2014.05.006. Epub 2014 Jun 2. PMID: 24889495.
6) Wu W, Li L, Qu C, Wang M, Liang S, Gao X, Bao X, Wang L, Liu H, Han H, Xu B, Zhou Y, Li B, Zhang Y, Wang G, Zhong C. Reflux finding score is associated with gastroesophageal flap valve status in patients with laryngopharyngeal reflux disease: a retrospective study. Sci Rep. 2019 Oct 31;9(1):15744. doi: 10.1038/s41598-019-52349-5. PMID: 31673091; PMCID: PMC6823359.
7) Inoue H, Imoto I, Taguchi Y, Kuroda M, Nakamura M, Horiki N, Oka S, Gabazza EC, Adachi Y. Reflux esophagitis after eradication of Helicobacter pylori is associated with the degree of hiatal hernia. Scand J Gastroenterol. 2004 Nov;39(11):1061-5. doi: 10.1080/00365520410008006. PMID: 15545162.
8) Kim GH, Song GA, Kim TO, Jo HJ, Kim DH, Heo J, Cho M, Kang DH. Endoscopic grading of gastroesophageal flap valve and atrophic gastritis is helpful to predict gastroesophageal reflux. J Gastroenterol Hepatol. 2008 Feb;23(2):208-14. doi: 10.1111/j.1440-1746.2007.05038.x. PMID: 18289353.
9) Chue KM, Goh DWX, Chua CME, Toh BC, Ong LWL, Wong WK, Lim CH, Tan JTH, Yeung BPM. The Hill's Classification Is Useful to Predict the Development of Postoperative Gastroesophageal Reflux Disease and Erosive Esophagitis After Laparoscopic Sleeve Gastrectomy. J Gastrointest Surg. 2022 Jun;26(6):1162-1170. doi: 10.1007/s11605-022-05324-x. PMID: 35445323.