HIATUS HERNIA ACCORDING TO THE MODIFIED MAKUUCHI CLASSIFICATION (HH)
- Doctors
- Feb 9, 2020
- 1 min read
Updated: Jun 13, 2020
Hiatus hernia according to the modified Makuuchi classification (HH)
The grades of HH:
Grade 0: no HH
Grade 1: partially HH
Grade 2: complete HH <3cm
Grade 3: complete HH ≥ 3cm
Measured by the scale on the endoscopic shaft
HH on retroflexed endoscopy
Grade I: Normal edge of tissue closely approximated to the scope
Grade II: Ridge is slightly less well defined and opens with respiration
Grade III: Ridge is effaced and the hiatus is patulous
Grade IV: Hiatus is wide open at all times and displaced axially
•Δ +: X ray
•Treatment:
–Medicines: PPI for GER symptoms
–Surgery: medical therapy not respond
The grade of Barrett Esophagus (BE)
BE: is extension of salmon-colored mucosa into the tubular esophagus extending ≥1cm proximal to the gastroesophageal junction and intestinal metaplasia on biopsy
• Grade 0: no BE
• Grade 2: circumferential [C]
or tongue [T] type, longest BE <1 cm
• Grade 2: C type, 3cm > longest
BE ≥1cm or T type, longest BE ≥1cm
• Grade 3: C type, shortest BE ≥3cm
Measured by the scale on the endoscopic shaft
Initial Management
•Biopsy: at least 8 random biopsies or 4 biopsies/cm of circumferential BE, and one biopsy/cm in tongues of BE
•Histology Δ +: intestinal metaplasia
•Treatment:
–PPI
–Endoscopy
–Surgery
•Repeat endoscopy: every 3 months to 5 years depends on grade and histolog
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