Evaluation of Gastroesophageal Reflux by Transabdominal Ultrasound in Adults: Focused on Subdiaphragmatic Esophageal Length, His angle, Moment of Reflux

The purpose of this retrospective study was to evaluate factors affecting the diagnosis of gastroesophageal reflux (GER) using transabdominal ultrasound.

The patient group comprised of 18 adults with upper endoscopy results of Los Angeles (LA)-classifications A or above, while the control group included of 68 adults with normal upper endoscopy. The ultrasonography was used to measure the subdiaphragmatic esophageal length, gastroesophageal angle (His angle) and real-time ultrasonography at the moment of reflux.

The subdiaphragmatic esophageal length was 29.2±3.6 mm in the control group, and 22.7±3.2 mm in the patient group. The results showed statistically significant difference between the two groups. The cut-off value for the subdiaphragmatic esophageal length was 25.1 mm. Sensitivity and specificity were 88.9% and 86.9% respectively. The gastroesophageal angle measured 121.9±12.3° in the control group and 141.5±8.8° in the patient group. The cut-off value of 134.6° showed a sensitivity of 83.3% and specificity of 83.8%. There were statistically significant differences (p = 0.001) during real-time ultrasonography with reflux in 77.8% of the patient group and 10.3% in the control group. The real-time ultrasonography showed a sensitivity of 77.8%, specificity of 89.7%, positive predictive value of 66.7% and negative predictive value 93.8%.

This study suggests that the transabdominal ultrasound used in measuring the subdiaphragmatic part of the esophageal length, His angle and real-time ultrasonography to be good predictive factors in diagnosing GER disease. Therefore, a medical examination with a noninvasive procedure such as transabdominal ultrasound may be a useful procedure in predicting gastroesophageal disorders.