Introduction: Esophageal manometry is not the ideal test for the diagnosis of hiatal hernias (HH); however, HH can be detected based on the finding of two distal high pressure zones, corresponding to the lower esophageal sphincter and the diaphragmatic crus (double hump sign). Conventional manometry has a sensitivity of 20% and a specificity of 99% for detecting HH. There are no reports of the detection of HH using high resolution manometry (HRM).
Aim: This study aims to evaluate the accuracy of HRM for the detection of sliding HH.
Methods: We reviewed 33 patients with foregut symptoms (15 females, median age 52 years) who had HRM performed in our laboratory. Patients with paraesophageal hernias, achalasia or previous foregut operations were excluded from the analysis. HH was defined on HRM as the presence of two distal high pressure zones separated by at least 1 cm. The presence of HH was confirmed by endoscopy and/or barium esophagram. All HRM studies were reviewed by a single investigator blinded to the results of the endoscopy and esophagram.
Results: HH was diagnosed by endoscopy and/or esophagram in 21 (63.6%) patients and detected by HRM in 11 (33.3%) patients. HRM had a sensitivity of 47.6%, specificity of 91.7%, positive predictive value of 0.9 and negative predictive value of 0.5 for the detection of HH.
Conclusion: High resolution manometry has low sensitivity and good specificity for the detection of HH. These results compared to previous reports, demonstrated an improvement of sensitivity compared to conventional manometry.