Journal of Gastroenterology

, Volume 53, Issue 6, pp 712–717 | Cite as

Endoscopic diagnosis of hiatus hernia under deep inspiration is not consistent with esophageal manometric diagnosis

  • Yuriko Hanada
  • Shintaro Hoshino
  • Yoshimasa Hoshikawa
  • Nana Takenouchi
  • Mariko Umezawa
  • Noriyuki Kawami
  • Katsuhiko Iwakiri
Original Article—Alimentary Tract



To investigate the relationship between endoscopic and esophageal manometric hiatus hernia (HH).


Forty-six gastroesophageal reflux disease patients with endoscopic HH under maintenance therapy were recruited. Endoscopy was performed on all patients in a fully conscious state. Endoscopic HH was defined as apparent separation greater than 1 cm of the lower margin of the esophageal palisade vessels and the diaphragm hiatus on endoscopy under deep inspiration. Esophageal manometry was conducted using high-resolution manometry (HRM). The length between the lower margin of the lower esophageal sphincter and pulmonary inversion point was measured 10 times. The mean and maximum of the length was then calculated.


The mean HH length on HRM was 0 cm (0–0) [median (25th to 75th percentile)], 0 cm (0-0), 0.5 cm (0–1.1), and 2.2 cm (1.3–2.5) in the groups with endoscopic HH lengths of 1–2, 2–3, 3–4, and 4–5 cm, respectively. The maximum HH length on HRM was 0 cm (0–0), 0 cm (0–0), 0.8 cm (0–1.4), and 2.4 cm (1.5–2.9) in the 1–2, 2–3, 3–4, and 4–5 cm endoscopic HH groups, respectively. The mean and maximum HH lengths increased significantly in the group with an endoscopic HH length of 4–5 cm compared with the other groups, but did not differ significantly among the 1–2, 2–3, and 3–4 cm groups. Of patients with endoscopic HH less than 3 cm, few had esophageal manometric HH greater than 2 cm.


Endoscopic diagnosis of HH under deep inspiration is not consistent with esophageal manometric diagnosis, leading to overdiagnosis.


Hiatus hernia Esophageal high-resolution manometry Endoscopy 



We would like to thank Dr. Yoshio Hoshihara for his helpful advice on our manuscript.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.


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Copyright information

© Japanese Society of Gastroenterology 2017

Authors and Affiliations

  • Yuriko Hanada
    • 1
  • Shintaro Hoshino
    • 1
  • Yoshimasa Hoshikawa
    • 1
  • Nana Takenouchi
    • 1
  • Mariko Umezawa
    • 1
  • Noriyuki Kawami
    • 1
  • Katsuhiko Iwakiri
    • 1
  1. 1.Department of GastroenterologyNippon Medical School, Graduate School of MedicineTokyoJapan

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