Ultrasonographic signs of sliding gastric hiatal hernia and 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 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 ranged from 16.0 to 21.0 mm. These two markers (nonvisualization of the junction and diameter greater than 16 mm) were then evaluated for their ability to predict the occurrence of sliding hiatus hernia in a prospective study of 38 patients subsequently diagnosed by means of barium contrast examinations 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 nonvisualization 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.