The grade I valve is a normal valve (Fig. Laparoscopic antireflux surgery (also called Nissen fundoplication) is used in the treatment … 3). 4 In grade I, which describes the normal appearance, prominent fold tissue closely approximates the endoscope at its entry point to the stomach. It opens but closes promptly (Fig. There was a similar distribution of hiatal hernia grading according to the modified Hill classification except for more patients with gastroesophageal flap valve grade I-II in the PF group (eTable 1 in Supplement 3). It tightens and reinforces the LES. Fig.2 Endoscopic follow-up of anti-reflux mucosal ablation (ARMA).a Pre-ARMA. It opens for swallowing and belching, and closes promptly. Hill I: Wall-like gastroesophageal flap valve, always with tight closure round the endoscope Hill II: Gastroesophageal flap valve less marked, with respiration-dependent incomplete closure of the cardia round the endoscope During gastric inflation, the gastroesophageal flap valve (GEFV) provides a pressure gradient against the reflux of stomach contents . in 1987 , and later a grading system to evaluate reflux was proposed by Hill et al , . A normal Hill Grade I occurs when GE junction is hugging the endoscope, in a retroflexed, insufflated position, and there are no gaps, indicating the patient could be a good candidate for PPI treatment. However, it is not routinely used in clinical practice. Gastroesophageal reflux disease (GERD) is a digestive disorder that affects the lower esophageal sphincter (the muscular ring connecting the esophagus with the stomach). The grade II gastroesophageal valve is only slightly less well defined and shorter. These variations can be described using the Hill classification, which relies on the endoscopic aspect of the gastroesophageal valve seen from a retroflexed position. Hiatal hernia was diagnosed if the endoscopic rugal folds commenced > or = 2 cm above the diaphragm; competency of the esophagogastric valve was graded according to the Hill classification. This consists of a musculomucosal fold adherent to the endoscope through all phases of respiration. The gastroesophageal flap valve is inspected in inversion and classified into one of four categories [2]. ing structures of the gastroesophageal flap valve [12]. This study aimed to investigate the significance of GEFV grading and the associations to multichannel intraluminal impedance and pH monitoring (MII-pH) in children with GERD. Background Gastroesophageal flap valve (GEFV) endoscopic grading is reported to be associated with gastroesophageal reflux disease (GERD) in adults; however its role in pediatric groups remains unknown. Endoscopy in retroflexiondemonstrated significant hernia The upper part of the stomach is wrapped around the outside of the lower esophagus to … We report a systematic review and meta-analysis to determine association between … Most patients in both groups were taking PPIs on a regular basis for relief of GERD symptoms (eTable 2 in Supplement 3). The flap valve was first described in cadavers by Thor et al. This is the standard surgical treatment for GERD. 2). Hill’s classification provides a reproducible endoscopic grading system for esophagogastric junction morphology and competence, specifically whether the gastroesophageal flap valve (GEFV) is normal (grade I/II) or abnormal (grades III/IV). All pa-tients in the current study had grade II or III Hill’sflapvalve, which was considered to be the primary cause of refractory GERD [11,13].