The Relationship Between Using Multiplanar Reconstruction Of MDCT Measure The Hiatal Surface Area And Hiatal Hernia And Gastroesophageal Reflux Disease

ObjectiveThe esophageal hiatus is an elongated and obliquely oriented opening in the diaphragm that forms the tissue at the boundary of the esophageal hiatus.The changes and significance are rarely recognized.Studies have shown that the greater the hiatal surface area（HSA）,the greater the likelihood of recurrence of hiatal hernia（HH）.For patients with gastroesophageal reflux disease（GERD）undergoing fundoplication,large areas of esophageal hiatus are associated with decreased low esophageal sphincter（LES）pressure and increased acid reflux.In this study,we used multiplanar reconstruction（MPR）technique to measure the hiatal surface area under physiological conditions to understand the relationship between HSA and HH and GERD.It is hypothesized that the multidetector computed tomography（MDCT）findings of HSA have clinical implications for patients with GERD and HH undergoing medical or surgical treatment.MethodsThis study used a case-control study to retrospectively analyze the clinical data of 193 patients from the Zhongda Hospital affiliated to Southeast University from May 2014 to May 2018.We created two groups including HH and GERD,HH group showed HH on the MDCT scan of the chest and abdomen,and GERD group was diagnosed as GERD and received appropriate treatment without HH.In this experiment,we have set up matching control groups.MDCT post-processing and analysis were performed using Philips Intellispace Portal version 7.0.4 software to obtain the HSA.Two radiologists performed independently post-MDCT treatment and measurements to assess the consistency between the assessors.We compared both HSA measurement data and post-processing imaging results.Subjects with heartburn or acid reflux were reported to be positive for GERD on a standardized questionnaire.There was no HH in the control group of the HH group,no HH in the control group of the GERD group,no GERD symptoms were reported,and GERD-related drugs were denied.ResultsHH group:There are a total of 193 individuals available for population and MDCT information.Screening of MDCT data revealed that 36（3.3%）had definite HH,37（3.4%）were likely to have HH,and 5（0.5%）were likely to have HH.3 cases of imaging evidence showed that individuals who had undergone surgery on the gastroesophageal junction area were excluded,and 2 cases with incomplete MDCT images were excluded.36 patients confirmed hiatal hernia developed HH group.Among them,27 cases had type I（sliding type）and 9 cases had type III（mixed type）.The hiatus surface area in the HH group was significantly larger than that in the control group（P<0.001）.Subjects in the HH group had an average HSA of 8.7±6.3（cm²）and the control group had an average HSA of 2.6±0.9（Figure 2）.The mean HSA for patients with type I（sliding）sputum was 6.9±5.3,and the mean HSA for type III（mixed）sputum subjects was significantly greater at13.9±6.0.The mean HSA of type I hiatal hernia was also larger than the mean HSA of innocent subjects（Figure 3）.Two radiologists independently analyzed 36 MDCT scans with a correlation coefficient of 0.998（p<0.001;Figure 4）.GDRD group:A total of 92 subjects in the GERD group without hiatal hernia were reported to have GERD,69 of whom were taking GERD-related drugs.56 subjects took proton pump inhibitors,9 subjects took H₂ receptor antagonists,3 subjects took proton pump inhibitors and H₂ receptor antagonists simultaneously,and the other one took other anti-reflux drugs.Of these,45 subjects did not have HH and formed the GERD group.The control group was matched to 45 subjects with demographic data.There were 42%and 49%males（p=0.34）in the GERD group and the control group,with BMI of 25.0±1.6、24.8±2.3（p=0.74）,ages of67.3±11.4and 68.6±9.6（p=0.57）.The mean HSA of the GERD group was 3.7±2.10cm²,while the mean HSA of the control group was 2.8±1.9cm²,which was not statistically significant（p=0.20;Figure 2）.The HSA cut-off value of>5.8 cm² has a sensitivity of 56%and a specificity of 93%for the presence of GERD.Two radiologists independently analyzed 36 MDCT scans with a correlation coefficient of 0.998,p<0.001.42% of patients with HH have GERD,compared with 10%for those without HH.35%of patients with HH have type GERD,while 60%of patients with type III HH have GERD.In this sample,when HH and HH-free subjects were analyzed as a separate group,those with no GERD had an average HSA of 3.9±2.7,and those with GERD had an average HSA of 7.3±4.9（p=0.02）.Conclusion1.This study finds that the HSA in patients with HH was significantly larger than that of the control group.The mean HSA of type I hiatal hernia is larger than the mean HSA of subjects without HH.We used MDCT,MPR technique to restore the spatial structure of esophageal hiatus,more intuitively measured HSA in vivo,and established a normal size range.This approach has the potential to guide preoperative anti-reflux surgery decisions and assess the long-term outcome of surgery.2.Some patients with hiatal hernia have gastroesophageal reflux disease,larger HSA is more prone to acid reflux symptoms.This study found that the existence of HH is associated with larger HSA and GERD.However,HSA does not distinguish between patients with GERD who have no hiatal hernia.