The Korean journal of internal medicine

The Korean Association of Internal Medicine (대한내과학회)
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Analysis of computed tomographic findings according to gastroesophageal flap valve grade

  • Jeon, Hye Kyung (Department of Internal Medicine, Pusan National University School of Medicine, and Biomedical Research Institute, Pusan National University Hospital) ;
  • Kim, Gwang Ha (Department of Internal Medicine, Pusan National University School of Medicine, and Biomedical Research Institute, Pusan National University Hospital) ;
  • Lee, Nam Kyung (Department of Radiology, Pusan National University School of Medicine, and Biomedical Research Institute, Pusan National University Hospital) ;
  • Kim, Suk (Department of Radiology, Pusan National University School of Medicine, and Biomedical Research Institute, Pusan National University Hospital) ;
  • Lee, Bong Eun (Department of Internal Medicine, Pusan National University School of Medicine, and Biomedical Research Institute, Pusan National University Hospital) ;
  • Song, Geun Am (Department of Internal Medicine, Pusan National University School of Medicine, and Biomedical Research Institute, Pusan National University Hospital)
  • Received : 2016.01.14
  • Accepted : 2016.10.21
  • Published : 2018.03.01
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Abstract

Background/Aims: The gastroesophageal junction is an important barrier against gastroesophageal reflux. Endoscopic grading of gastroesophageal flap 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 flap 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, $65.2^{\circ}{\pm}19.6^{\circ}$; grade II, $66.6^{\circ}{\pm}19.8^{\circ}$; grade III, $76.7^{\circ}{\pm}11.9^{\circ}$; grade IV, $120.0^{\circ}{\pm}30.3^{\circ}$; p < 0.001), as did the size of the diaphragmatic hiatus (grade I, $213.0{\pm}53.8mm^2$; grade II, $232.6{\pm}71.0mm^2$; grade III, $292.3{\pm}99.2mm^2$; grade IV, $584.4{\pm}268.3$; p < 0.001). The length of the abdominal esophagus decreased as gastroesophageal flap valve grade increased (grade I, $34.6{\pm}5.8mm$; grade II, $32.0{\pm}6.5mm$; grade III, $24.6{\pm}7.8mm$; grade IV, $-22.6{\pm}38.2mm$; 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.

Keywords

Acknowledgement

Supported by : Pusan National University Hospital

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