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Esophagogastric Junction Morphology on Hill’s Classification Predicts Gastroesophageal Reflux with Good Accuracy and Consistency

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Abstract

Introduction

Hill’s classification provides a reproducible endoscopic grading system for esophagogastric junction morphology and competence, specifically whether the gastroesophageal flap valve (GEFV) is normal (grade I/II) or abnormal (grades III/IV). However, it is not routinely used in clinical practice. We report a systematic review and meta-analysis to determine association between abnormal GEFV and gastroesophageal reflux disorder (GERD).

Methods

A comprehensive literature search of MEDLINE and Scopus databases was conducted to identify studies that reported the association between abnormal GEFV and GERD. The search and quality assessment were performed independently by two authors. Fixed- and random-effects meta-analyses were conducted using symptomatic GERD and erosive esophagitis as outcomes.

Results

A total of 11 studies met inclusion criteria that included a total of 5054 patients. In the general population, patients with abnormal GEFV had greater risk of symptomatic GERD compared to patients with a normal GEFV (risk ratio [RR] 1.88, 95% CI 1.57–2.24). Further, in patients with symptomatic GERD, patients with abnormal GEFV had greater risk of erosive esophagitis compared to patients with normal GEFV (RR 2.17, 95% CI 1.40–3.36). Finally, the specificity of abnormal GEFV for symptomatic GERD was 73.3% (95% CI 69.3–77.0%) and 75.7% (95% CI 65.9–83.4%) for erosive esophagitis in symptomatic GERD.

Conclusion

Our systematic review and meta-analysis showed consistent association between abnormal GEFV indicated by Hill’s classification III/IV and symptomatic GERD and erosive esophagitis. Our recommendation is to include Hill’s classification in routine endoscopy reports and workup for GERD.

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Authors and Affiliations

  1. Division of Internal Medicine, Department of Medicine, Creighton University, Omaha, NE, USA

    Ali Osman & Manal M. Albashir

  2. Department of Surgery, Creighton University, School of Medicine, Omaha, NE, USA

    Kalyana Nandipati

  3. Division of Clinical Research and Evaluative Sciences, Department of Medicine, Creighton University, Omaha, NE, USA

    Ryan W. Walters

  4. Division of Gastroenterology, Department of Medicine, CHI Health Creighton University Medical Center – Bergan Mercy, 7710 Mercy Road, CU Education Building, Suite 401, Omaha, NE, 68124, USA

    Subhash Chandra

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  1. Ali Osman
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  2. Manal M. Albashir
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  3. Kalyana Nandipati
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  4. Ryan W. Walters
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  5. Subhash Chandra
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Correspondence to Subhash Chandra.

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Osman, A., Albashir, M.M., Nandipati, K. et al. Esophagogastric Junction Morphology on Hill’s Classification Predicts Gastroesophageal Reflux with Good Accuracy and Consistency. Dig Dis Sci 66, 151–159 (2021). https://doi.org/10.1007/s10620-020-06146-0

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  • DOI: https://doi.org/10.1007/s10620-020-06146-0

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