Korean J Intern Med.
2018 Mar;33(2):295-303. 10.3904/kjim.2016.023.
Analysis of computed tomographic findings according to gastroesophageal flap valve grade
- Affiliations
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- 1Department of Internal Medicine, Pusan National University School of Medicine, and Biomedical Research Institute, Pusan National University Hospital, Busan, Korea. doc0224@pusan.ac.kr
- 2Department of Radiology, Pusan National University School of Medicine, and Biomedical Research Institute, Pusan National University Hospital, Busan, Korea.
- KMID: 2411541
- DOI: http://doi.org/10.3904/kjim.2016.023
Abstract
- BACKGROUND/AIMS
The gastroesophageal junction is an important barrier against gastroesophageal ref lux. Endoscopic grading of gastroesophageal f lap valve is simple, reproducible, and may predict reflux activity. We investigated the correlation between gastroesophageal flap valve grade and the gastroesophageal junction's structural properties using abdominal computed tomography.
METHODS
A total of 138 patients with early gastric cancer who underwent both pre-treatment esophagogastroduodenoscopy and water-distended stomach two-phase computed tomography were enrolled. Endoscopic gastroesophageal f lap valve grade and abdominal computed tomography findings were analyzed to assess anatomical factors including the gastroesophageal junction and related organs.
RESULTS
The angle of His increased significantly with gastroesophageal flap valve grade (grade I, 65.2Ëš± 19.6Ëš; grade II, 66.6Ëš± 19.8Ëš; grade III, 76.7Ëš± 11.9Ëš; grade IV, 120.0Ëš± 30.3Ëš; p < 0.001), as did the size of the diaphragmatic hiatus (grade I, 213.0 ± 53.8 mm2 ; grade II, 232.6 ± 71.0 mm2 ; grade III, 292.3 ± 99.2 mm2 ; grade IV, 584.4 ± 268.3; p < 0.001). The length of the abdominal esophagus decreased as gastroesophageal flap valve grade increased (grade I, 34.6 ± 5.8 mm; grade II, 32.0 ± 6.5 mm; grade III, 24.6 ± 7.8 mm; grade IV, -22.6 ± 38.2 mm; p < 0.001). There was no significant relationship between gastroesophageal flap valve grade and visceral and subcutaneous fat areas (p = 0.877 and p = 0.508, respectively).
CONCLUSIONS
Endoscopic grading of the gastroesophageal flap valve is well correlated with anatomical changes around the gastroesophageal junction on abdominal computed tomography, and it can provide useful information about the anti-reflux barrier.
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