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.