Abstract：
BACKGROUND: The Hill classification characterizes the geometry of gastroesophageal junction and Hill grades (HGs) III and IV have a high association with pathologic reflux. This study aimed to understand the use of the Hill classification and correlate the prevalence of pathologic reflux across different HGs.
METHODS: A retrospective review of 477 patients who underwent upper endoscopy and BRAVO pH monitoring between August 2018 and October 2021 was performed. These charts were reviewed for endoscopic findings for hiatal hernia and association of HGs with pathologic reflux, defined as an abnormal esophageal acid exposure time (AET) of ≥4.9%.
RESULTS: Of 477 patients, 252 (52.8%) had an HG documented on the endoscopy report. Of the 252 patients, 61 had HG I (24.2%), 100 had HG II (39.7%), 61 had HG III (24.2%), and 30 had HG IV (11.9%). The proportion of patients with abnormal AET increases with increasing HGs (p < 0.001) as follows: I (39.3%), II (52.5%), III (67.2%), and IV (79.3%). The mean overall AET is as follows: HG I (5.5 ± 6%), HG II (7.0 ± 5.9%), HG III (10.2 ± 10.3%), and HG IV (9.5 ± 5.5%). The proportion of patients with hiatal hernia was 18% for HG I, 28% for HG II, 39.3% for HG III, and 80% for HG IV.
CONCLUSIONS: Use of the Hill classification in clinical practice is low. There is an association of increasing HGs with increasing proportion of patients with abnormal AET. There is a high proportion of patients within HGs I and II with documented pathologic reflux and the presence of a hiatal hernia as observed on endoscopic examination. Our study suggests that endoscopic grading of the gastroesophageal junction may not adequately differentiate between normal vs abnormal reflux status, particularly for HGs I and II.
METHODS: A retrospective review of 477 patients who underwent upper endoscopy and BRAVO pH monitoring between August 2018 and October 2021 was performed. These charts were reviewed for endoscopic findings for hiatal hernia and association of HGs with pathologic reflux, defined as an abnormal esophageal acid exposure time (AET) of ≥4.9%.
RESULTS: Of 477 patients, 252 (52.8%) had an HG documented on the endoscopy report. Of the 252 patients, 61 had HG I (24.2%), 100 had HG II (39.7%), 61 had HG III (24.2%), and 30 had HG IV (11.9%). The proportion of patients with abnormal AET increases with increasing HGs (p < 0.001) as follows: I (39.3%), II (52.5%), III (67.2%), and IV (79.3%). The mean overall AET is as follows: HG I (5.5 ± 6%), HG II (7.0 ± 5.9%), HG III (10.2 ± 10.3%), and HG IV (9.5 ± 5.5%). The proportion of patients with hiatal hernia was 18% for HG I, 28% for HG II, 39.3% for HG III, and 80% for HG IV.
CONCLUSIONS: Use of the Hill classification in clinical practice is low. There is an association of increasing HGs with increasing proportion of patients with abnormal AET. There is a high proportion of patients within HGs I and II with documented pathologic reflux and the presence of a hiatal hernia as observed on endoscopic examination. Our study suggests that endoscopic grading of the gastroesophageal junction may not adequately differentiate between normal vs abnormal reflux status, particularly for HGs I and II.
摘要：
背景：Hill分类表征胃食管交界处（GEJ）的几何形状，Hill分级（HGs）III和IV与病理性反流高度相关。这项研究旨在了解Hill分类的利用情况，并关联不同HG之间病理性反流的患病率。
方法：对2018年8月至2021年10月接受上消化道内窥镜检查和BRAVO™pH监测的477例患者进行了回顾性回顾。对这些图表进行了回顾，以了解食管裂孔疝的内镜发现以及HGs与病理性反流的关系。定义为食管酸异常暴露时间（AET）≥4.9%。
结果：在477名患者中，252（52.8％）在内窥镜检查报告中记录了HG。252名患者中,61人患有HGI（24.2%）；100人患有HGII（39.7%）；61人患有HGIII（24.2%）；30人患有HGIV（11.9%）。AET异常患者的比例随着HGs的增加而增加（p<0.001）：I（39.3％），II（52.5%），III（67.2%），IV（79.3%）。平均总体AET如下：HGI(5.5±6.0%)，HGII(7.0±5.9%),HGIII(10.2±10.3%),和HGIV（9.5±5.5％）。HGⅠ型食管裂孔疝患者比例为18.0%,HGII的28.0%，HGIII为39.3%，HGIV为80.0%。
结论：Hill分类在临床实践中的应用很少。HG的增加与AET异常患者比例的增加有关。如在内窥镜检查中观察到的，在HGI和II中，有很高比例的患者有病理性反流和食管裂孔疝的存在。我们的研究表明，GEJ的内镜分级可能无法充分区分正常和异常反流状态，特别是对于HGI和II。
方法：对2018年8月至2021年10月接受上消化道内窥镜检查和BRAVO™pH监测的477例患者进行了回顾性回顾。对这些图表进行了回顾，以了解食管裂孔疝的内镜发现以及HGs与病理性反流的关系。定义为食管酸异常暴露时间（AET）≥4.9%。
结果：在477名患者中，252（52.8％）在内窥镜检查报告中记录了HG。252名患者中,61人患有HGI（24.2%）；100人患有HGII（39.7%）；61人患有HGIII（24.2%）；30人患有HGIV（11.9%）。AET异常患者的比例随着HGs的增加而增加（p<0.001）：I（39.3％），II（52.5%），III（67.2%），IV（79.3%）。平均总体AET如下：HGI(5.5±6.0%)，HGII(7.0±5.9%),HGIII(10.2±10.3%),和HGIV（9.5±5.5％）。HGⅠ型食管裂孔疝患者比例为18.0%,HGII的28.0%，HGIII为39.3%，HGIV为80.0%。
结论：Hill分类在临床实践中的应用很少。HG的增加与AET异常患者比例的增加有关。如在内窥镜检查中观察到的，在HGI和II中，有很高比例的患者有病理性反流和食管裂孔疝的存在。我们的研究表明，GEJ的内镜分级可能无法充分区分正常和异常反流状态，特别是对于HGI和II。
