Sliding hiatal hernia detected by transnasal esophagogastroscopy is associated with poorer treatment response in reflux-associated globus sensation

Transnasal esophagogastroscopy (TNE) may provide clinically relevant information on gastroesophageal junction morphology in patients with globus sensation and reflux disease. This prospective single-arm interventional cohort study with a pre-post design evaluated the association between TNE findings and treatment response in patients with objectively confirmed reflux disease. Ninety-two patients with globus sensation underwent dual-probe pH monitoring; reflux disease was detected in 59 patients. These patients underwent TNE and completed the German version of the Glasgow Edinburgh Throat Scale (GETS-G) before and after 12 weeks of antireflux treatment. Pathological TNE findings were identified in 25 patients, with sliding hiatal hernia being the most frequent abnormality (18 patients). The mean GETS-G score decreased significantly from 38.5 ± 7.1 to 24.0 ± 8.1 after treatment. Using the ≥ 20% GETS-G reduction threshold, 48 of 59 patients met the study-defined response criterion. Sliding hiatal hernia was not significantly associated with reflux subtype but was independently associated with poorer symptom improvement. Hill grades I–II were associated with greater improvement than Hill grades III–IV. Endoscopic assessment of hiatal hernia and Hill classification may support individualized management of reflux-associated globus sensation.