ArticleEndoscopy international open2016
Hill classification is superior to the axial length of a hiatal hernia for assessment of the mechanical anti-reflux barrier at the gastroesophageal junction.
Article in Endoscopy international open, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 2 registered trials, which are not on this map. Cited by 29 papers, 2 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Antireflux Ablation Therapy (ARAT) With Hybrid-APC (Argon Plasma Coagulation) for GERD Treatment in Patients Without Hiatal Hernia
A Randomized Controlled Trial Evaluating PAtients With Lax Gastroesophageal Junction to Initial Sleeve Gastrectomy With or Without Concomitant Crural Repair (REPAIR)
Who cites it
29 citing papers in PubMed, 2 syntheses or guidelines pooled it, 69 citations in OpenAlex.
- Quality Upper Gastrointestinal Endoscopy in Australia and Aotearoa New Zealand: A Joint Position Statement.Journal of gastroenterology and hepatology · 2025Guideline
- Esophagogastric Junction Morphology on Hill's Classification Predicts Gastroesophageal Reflux with Good Accuracy and Consistency.Digestive diseases and sciences · 2021Pooled it
- Factors influencing the outcome of magnetic sphincter augmentation for chronic gastroesophageal reflux disease.Surgical endoscopy · 2018Trial
- Sliding hiatal hernia detected by transnasal esophagogastroscopy is associated with poorer treatment response in reflux-associated globus sensation.Scientific reports · 2026Article
- Postoperative quality of life after minimally invasive repair of giant hiatal hernias.Hernia : the journal of hernias and abdominal wall surgery · 2026Article
- The American Foregut Society endoscopic classification outperforms Hill in phenotyping the esophago-gastric junction to guide gastroesophageal reflux disease management.Diseases of the esophagus : official journal of the International Society for Diseases of the Esophagus · 2026Article
- Observational study of Reflux-related findings at distal esophagus, gastric pouch, and anastomotic site one and three years after one-anastomosis gastric bypass: exploring the diagnostic accuracy of endoscopy compared to biopsy.BMC gastroenterology · 2025Observational
- Reflux-Related Abnormalities at Distal oesophagus, Gastric Pouch and Anastomotic Site 4 Years After OAGB: Diagnostic Accuracies of Endoscopy Compared to Biopsy and of Symptoms Compared to Both.Obesity surgery · 2025Article
- Constructing an artificial intelligence-assisted system for the assessment of gastroesophageal valve function based on the hill classification (with video).BMC medical informatics and decision making · 2025Article
- Prospective Evaluation of Real-Time Artificial Intelligence for the Hill Classification of the Gastroesophageal Junction.United European gastroenterology journal · 2025Article
- Established and Novel Methods to Assess GERD: An Update.Visceral medicine · 2024Review
- The Saudi Gastroenterology Association consensus on the clinical care pathway for the diagnosis and treatment of GERD.Saudi journal of gastroenterology : official journal of the Saudi Gastroenterology Association · 2024Article
- Efficient artificial intelligence-based assessment of the gastroesophageal valve with Hill classification through active learning.Scientific reports · 2024Article
- Article
- Hiatal hernia reporting: time to remove subjectivity?Surgical endoscopy · 2024Article
- What is the significance of the Hill classification?Diseases of the esophagus : official journal of the International Society for Diseases of the Esophagus · 2023Article
- Predicting reflux symptom recurrence: The impact of gastroesophageal junction indicators and body mass index among outpatients.Experimental and therapeutic medicine · 2023Article
- Role of Endoscopy in Motility Disorders of Upper Gastrointestinal Tract.Journal of neurogastroenterology and motility · 2023Review
- The Hill's Classification Is Useful to Predict the Development of Postoperative Gastroesophageal Reflux Disease and Erosive Esophagitis After Laparoscopic Sleeve Gastrectomy.Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract · 2022Article
- New endoscopic capsule vs upper gastrointestinal endoscopy in preoperative work-up of obese candidate for bariatric surgery: Relevance of a pilot study in the COVID-19 era.Endoscopy international open · 2022Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
9 authors at 6 institutions in 3 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
BACKGROUND AND STUDY
aimsThe pathogenesis of gastroesophageal reflux disease (GERD) is multifactorial, including the mechanical anti-reflux barrier of the gastroesophageal junction. This barrier can be evaluated endoscopically in two ways: by measuring the axial length of any hiatal hernia present or by assessing the gastroesophageal flap valve. The endoscopic measurement of axial length is troublesome because of the physiological dynamics in the area. Grading the gastroesophageal flap valve is easier and has proven reproducible. The aim of the present study was to compare the two endoscopic grading methods with regard to associations with GERD. PATIENTS AND
methodsPopulation-based subjects underwent endoscopic examination assessing the axial length of hiatus hernia, the gastroesophageal flap valve using the Hill classification, esophagitis using the Los Angeles (LA) classification, and columnar metaplasia using the Z-line appearance (ZAP) classification. Biopsies were taken from the squamocolumnar junction to assess the presence of intestinal metaplasia. Symptoms were recorded with the validated Abdominal Symptom Questionnaire. GERD was defined according to the Montreal definition.
resultsIn total, 334 subjects were included in the study and underwent endoscopy; 86 subjects suffered from GERD and 211 presented no symptoms or signs of GERD. Based on logistic regression, the estimated area under the curve statistic (AUC) for Hill (0.65 [95 %CI 0.59 - 0.72]) was higher than the corresponding estimate for the axial length of a hiatal hernia (0.61 [95 %CI 0.54 - 0.68]), although the difference was not statistically significant (P = 0.225).
conclusionFrom our data, and in terms of association with GERD, the Hill classification was slightly stronger compared to the axial length of a hiatal hernia, but we could not verify that the Hill classification was superior as a predictor. The Hill classification may replace the axial length of a hiatal hernia in the endoscopic assessment of the mechanical anti-reflux barrier of the gastroesophageal junction.
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.