Hiatal hernia size is the dominant determinant of esophagitis presence andseverity in gastroesophageal reflux disease

OBJECTIVE: Although reflux esophagitis is a multifactorial disease, the rel ative importance of these pathogenetic factors has not been clearly establi shed. In this study, regression analysis was used to model the major determ inants of esophagitis in patients with symptomatic gastroesophageal reflux disease (GERD). METHODS: Sixty-six GERD patients and 16 asymptomatic controls were evaluate d. All patients underwent upper endoscopy, esophageal manometry, and 24-h p H monitoring. Esophagrams were performed in 38 of the GERD patients and all controls. Stepwise regression was performed using esophagitis severity as the dependent variable. Logistic regression was performed grouping subjects as controls, nonerosive GERD, or erosive esophagitis. RESULTS: Hiatal hernia size, lower esophageal sphincter pressure, esophagea l acid exposure, and number of reflux episodes >5 min significantly correla ted with esophagitis severity. Stepwise regression identified hiatal hernia size (p = 0.0001) and lower esophageal sphincter pressure (p = 0.0024) as significant predictors of esophagitis. Logistic regression also identified hiatal hernia size (chi (2) = 17.07, p < 0.0001) and lower esophageal sphin cter pressure (chi (2) = 5.97, p = 0.0146) as significant predictors of ero sive esophagitis. CONCLUSION: Esophagitis severity is best predicted by hiatal hernia size an d lower esophageal sphincter pressure. Of these, hiatal hernia size is the strongest predictor. (C) 2001 by Am. Cell. of Gastroenterology.