Fig. 3.

70-year-old female with history of hiatal hernia and chronic gastroesophageal reflux disease (GERD), referred for pre-operative evaluation of hernia. Patient underwent same day HRM prior to BAS. HRM revealed hiatal hernia, low basal lower esophageal sphincter pressure, and fragmented peristalsis. a BAS demonstrated no abnormality of the upper 2/3 esophagus. b A Schatzki ring (arrow) was present in the lower esophagus on standing air contrast LPO views. c During supine RPO reflux maneuvers, a type III paraesophageal hernia was noted involving the gastric cardia and fundus with superior displacement of the gastroesophageal junction. Barium esophageal coating was graded adequate to optimal (grade 3.33)