Frontiers in medicine · 2026
The "ABCD" framework for assessment: a task-oriented approach to reconcile multimodal diagnostic discordance.
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Mijiti Wubulikasimu, Apaer Shadike, Han Xu, Dong Qiang, Cao Xinling
Аннотация
BACKGROUND: Pre-operative assessment of hiatal hernia (HH) often reveals discordance between endoscopy, barium swallow, and high-resolution manometry (HRM). These discrepancies can lead to diagnostic uncertainty and suboptimal surgical planning. We propose the "ABCD" framework to integrate these multimodal findings into a clinical-task-oriented decision process.
METHODS: A comprehensive review of current diagnostic standards (Chicago 4.0, Lyon 2.0, AFS-LDF classification) and emerging technologies, including artificial intelligence (AI), was conducted to identify common points of diagnostic discordance and their clinical implications.
RESULTS: The ABCD framework categorizes assessment into four essential domains: anatomical confirmation (presence and type), Barrier phenotyping (EGJ integrity using Hill and AFS-LDF systems), Clinical consequences (reflux burden and symptoms), and Decision support (integrating data for surgical planning). This framework clarifies that discordance-such as a large hernia on imaging with a functional barrier on HRM-often reflects different dimensions of the EGJ rather than test failure. AI-assisted endoscopic grading may further improve reproducibility, although its clinical utility requires external validation.
CONCLUSION: The ABCD framework offers a structured, task-oriented approach for integrating multimodal HH assessment rather than a fully validated decision algorithm. By shifting focus from "the best test" to multidimensional clinical tasks, this framework may facilitate patient selection and perioperative decision-making, but its impact on clinical outcomes requires prospective validation.
METHODS: A comprehensive review of current diagnostic standards (Chicago 4.0, Lyon 2.0, AFS-LDF classification) and emerging technologies, including artificial intelligence (AI), was conducted to identify common points of diagnostic discordance and their clinical implications.
RESULTS: The ABCD framework categorizes assessment into four essential domains: anatomical confirmation (presence and type), Barrier phenotyping (EGJ integrity using Hill and AFS-LDF systems), Clinical consequences (reflux burden and symptoms), and Decision support (integrating data for surgical planning). This framework clarifies that discordance-such as a large hernia on imaging with a functional barrier on HRM-often reflects different dimensions of the EGJ rather than test failure. AI-assisted endoscopic grading may further improve reproducibility, although its clinical utility requires external validation.
CONCLUSION: The ABCD framework offers a structured, task-oriented approach for integrating multimodal HH assessment rather than a fully validated decision algorithm. By shifting focus from "the best test" to multidimensional clinical tasks, this framework may facilitate patient selection and perioperative decision-making, but its impact on clinical outcomes requires prospective validation.