Endoscopic Anatomy of Hiatal Hernia and its Relationship with C-Reactive Protein Levels: A Case-Control Study

Arif Keskin; Tayfun Aygün; Ahmet Dülger; Özlem Aydın Berktaş

doi:10.70058/cjm.1921979

Endoscopic Anatomy of Hiatal Hernia and its Relationship with C-Reactive Protein Levels: A Case-Control Study

Abstract

Objective: This study aimed to evaluate the relationship between endoscopically determined hiatal hernia and C-reactive protein (CRP) levels in patients.

Methods: This retrospective case-control study was conducted among 166 patients who underwent upper gastrointestinal endoscopy at Giresun Training and Research Hospital between March 2024 and May 2025. Of these patients, 83 were with hiatal hernia (case group), and 83 were without hiatal hernia (control group), matched by age and gender in a 1:1 ratio. Hiatal hernia was diagnosed endoscopically when the distance between the Z-line and the gastroesophageal junction (GEJ) exceeded 2 cm. Demographic characteristics, endoscopic parameters such as GEJ level and Z-GEJ distance, concomitant endoscopic findings, and CRP levels were compared between the groups.

Results: The groups were demographically homogeneous regarding age (66.72±13.70 vs 66.19±13.70 years, P>0.05) and gender distribution (P=1.00). GEJ level and Z-GEJ distance were significantly higher in the case group (P<0.001). CRP levels were significantly elevated in the hiatal hernia group compared to controls (9.29±25.45 vs 3.01±7.62 mg/L, P<0.001). The prevalence of gastritis and duodenitis was significantly higher in the case group (P<0.001). ROC analysis demonstrated an area under the curve of 0.696 (95% CI: 0.617-0.776) for CRP at a cut-off value of 2.215 mg/L, with 67.5% sensitivity, 63.9% specificity, and 65.7% accuracy. However, CRP was not found to be an independent predictor of hiatal hernia in multivariate logistic regression analysis, suggesting that its elevation may reflect a broader systemic inflammatory context.

Conclusion: Patients with hiatal hernia showed elevated CRP levels on univariate analysis, suggesting a systemic inflammatory component. While CRP may serve as a supportive biomarker reflecting inflammatory burden, its independent predictive value was limited in multivariate analysis. Therefore, it cannot be used as a standalone diagnostic test and should complement endoscopic evaluation.

Keywords

Ethical Statement

This study was conducted in accordance with the principles of the Declaration of Helsinki and approved by the Giresun Training and Research Hospital Scientific Research Ethics Committee (Approval Date: 22.08.2025; Approval Number: 20.08.2025/05). Due to the retrospective design, patient consent was not obtained.

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Details

Primary Language

English

Subjects

Anatomy

Journal Section

Research Article

Authors

Arif Keskin ^*
0000-0002-1634-1091
Türkiye

Tayfun Aygün
0000-0001-5058-3513
Türkiye

Ahmet Dülger
0000-0002-9328-5185
Türkiye

Özlem Aydın Berktaş
0000-0002-7235-4890
Türkiye

Early Pub Date

May 19, 2026

Publication Date

May 31, 2026

Submission Date

April 2, 2026

Acceptance Date

May 17, 2026

Published in Issue

Year 2026 Volume: 3 Number: 2

DOI

https://doi.org/10.70058/cjm.1921979

IZ

https://izlik.org/JA96KU37RB

Cite

RIS / Bibtex

APA

Keskin, A., Aygün, T., Dülger, A., & Aydın Berktaş, Ö. (2026). Endoscopic Anatomy of Hiatal Hernia and its Relationship with C-Reactive Protein Levels: A Case-Control Study. Cerasus Journal of Medicine, 3(2), 124-131. https://doi.org/10.70058/cjm.1921979

AMA

1.Keskin A, Aygün T, Dülger A, Aydın Berktaş Ö. Endoscopic Anatomy of Hiatal Hernia and its Relationship with C-Reactive Protein Levels: A Case-Control Study. Cerasus J Med. 2026;3(2):124-131. doi:10.70058/cjm.1921979

Chicago

Keskin, Arif, Tayfun Aygün, Ahmet Dülger, and Özlem Aydın Berktaş. 2026. “Endoscopic Anatomy of Hiatal Hernia and Its Relationship With C-Reactive Protein Levels: A Case-Control Study”. Cerasus Journal of Medicine 3 (2): 124-31. https://doi.org/10.70058/cjm.1921979.

EndNote

Keskin A, Aygün T, Dülger A, Aydın Berktaş Ö (May 1, 2026) Endoscopic Anatomy of Hiatal Hernia and its Relationship with C-Reactive Protein Levels: A Case-Control Study. Cerasus Journal of Medicine 3 2 124–131.

IEEE

[1]A. Keskin, T. Aygün, A. Dülger, and Ö. Aydın Berktaş, “Endoscopic Anatomy of Hiatal Hernia and its Relationship with C-Reactive Protein Levels: A Case-Control Study”, Cerasus J Med, vol. 3, no. 2, pp. 124–131, May 2026, doi: 10.70058/cjm.1921979.

ISNAD

Keskin, Arif - Aygün, Tayfun - Dülger, Ahmet - Aydın Berktaş, Özlem. “Endoscopic Anatomy of Hiatal Hernia and Its Relationship With C-Reactive Protein Levels: A Case-Control Study”. Cerasus Journal of Medicine 3/2 (May 1, 2026): 124-131. https://doi.org/10.70058/cjm.1921979.

JAMA

1.Keskin A, Aygün T, Dülger A, Aydın Berktaş Ö. Endoscopic Anatomy of Hiatal Hernia and its Relationship with C-Reactive Protein Levels: A Case-Control Study. Cerasus J Med. 2026;3:124–131.

MLA

Keskin, Arif, et al. “Endoscopic Anatomy of Hiatal Hernia and Its Relationship With C-Reactive Protein Levels: A Case-Control Study”. Cerasus Journal of Medicine, vol. 3, no. 2, May 2026, pp. 124-31, doi:10.70058/cjm.1921979.

Vancouver

1.Arif Keskin, Tayfun Aygün, Ahmet Dülger, Özlem Aydın Berktaş. Endoscopic Anatomy of Hiatal Hernia and its Relationship with C-Reactive Protein Levels: A Case-Control Study. Cerasus J Med. 2026 May 1;3(2):124-31. doi:10.70058/cjm.1921979