Endoscopic assessment of the gastroesophageal junction for predicting gastroesophageal reflux disease

Objective This study was conducted to evaluate the predictive value of endoscopic measurements of cardia opening diameter and sliding hernia length for diagnosing gastroesophageal reflux disease. Methods A total of 233 patients with typical gastroesophageal reflux disease symptoms who underwent endoscopy and esophageal pH-impedance monitoring between September 2017 and September 2023 were enrolled in this study. Cardia opening diameter and sliding hernia length were measured during endoscopy under adequate gastric insufflation. Using esophageal pH-impedance monitoring as the gold standard (with acid exposure time >4% as the diagnostic criterion for gastroesophageal reflux disease), the correlation between cardia opening diameter/sliding hernia length and gastroesophageal reflux disease-related parameters was analyzed. A nomogram prediction model was subsequently developed. Results The optimal cutoff values for predicting pathological acid reflux were cardia opening diameter >2 cm and sliding hernia length >1 cm (area under the receiver operating characteristic curve = 0.648 for both). Compared with patients with a cardia opening diameter ≤2 cm, those with a cardia opening diameter >2 cm had significantly higher acid exposure time (6.8% vs. 2.5%), DeMeester score (25.7 vs. 10.9), and number of reflux episodes (108 vs. 59) (all p < 0.001). Similarly, sliding hernia length >1 cm was associated with more severe reflux parameters ( p < 0.05) and was more prevalent in males (72.4% vs. 43.6%). Univariate and multivariate logistic regression analyses demonstrated that a nomogram incorporating age, body mass index, and sliding hernia length exhibited good predictive performance (area under the curve = 0.739). Conclusion Endoscopically assessed cardia opening diameter and sliding hernia length are useful functional predictors of gastroesophageal reflux disease. The integrated prediction model may serve as a valuable diagnostic aid, especially in primary care or resource-limited settings.