The importance of endoscopic evaluation and grading of the gastroesophageal flap valve in patients with gastroesophageal reflux disease (GERD) was previously demonstrated with increased acid exposure and high grades of esophagitis in those with high-grade valves.
On the other hand, no data exist on the relationship between gastroesophageal flap valve appearance and surgical rate.
Dr Huseyin Ayhan Kayaoglu and colleagues reported that for 453 patients with symptoms suggestive of gastroesophageal reflux disease, gastroesophageal flap valve grading and 24-h ambulatory pH monitoring were performed.
Surgery was performed for 82 of these patients who failed medical management or had disease complications.
The research team noted that the gastroesophageal flap valve grade 4 patients were younger than the patients with normal gastroesophageal flap valve, and 2 and showed significant male predominance.
|5% of the grade 2 patients underwent surgery|
The prevalence of hiatal hernia, the degree of esophageal acid exposure, and the prevalence and degree of erosive esophagitis significantly increased with gastroesophageal flap valve grade.
The doctors examined that no gastroesophageal flap valve grade 1 patients underwent surgery compared with 5% of the grade 2 patients, 21% of the grade 3 patients, and 64% of the grade 4 patients who had surgery for various indications.
Dr Kayaoglu's team commented, "Esophagogastric opening estimated by endoscopic grading of the gastroesophageal flap valve was strongly correlated with surgery rate in gastroesophageal reflux disease patients."
"In particular, patients with grade 4 valves showed the highest rates of erosive esophagitis and axial hiatal hernia and frequently underwent surgery for either failed medical management or disease complications."