{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T06:19:28Z","timestamp":1783491568555,"version":"3.55.0"},"reference-count":53,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T00:00:00Z","timestamp":1783468800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>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 \u201cABCD\u201d framework to integrate these multimodal findings into a clinical-task-oriented decision process.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>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\u2014such as a large hernia on imaging with a functional barrier on HRM\u2014often 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>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 \u201cthe best test\u201d to multidimensional clinical tasks, this framework may facilitate patient selection and perioperative decision-making, but its impact on clinical outcomes requires prospective validation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2026.1885195","type":"journal-article","created":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T05:59:20Z","timestamp":1783490360000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["The \u201cABCD\u201d framework for assessment: a task-oriented approach to reconcile multimodal diagnostic discordance"],"prefix":"10.3389","volume":"13","author":[{"given":"Wubulikasimu","family":"Mijiti","sequence":"first","affiliation":[{"name":"Department of Hepatic Laparoscopic Surgery, The First Affiliated Hospital of Xinjiang Medical University","place":["Urumqi, Xinjiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shadike","family":"Apaer","sequence":"additional","affiliation":[{"name":"Department of Hepatic Laparoscopic Surgery, The First Affiliated Hospital of Xinjiang Medical University","place":["Urumqi, Xinjiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xu","family":"Han","sequence":"additional","affiliation":[{"name":"Department of Hepatic Laparoscopic Surgery, The First Affiliated Hospital of Xinjiang Medical University","place":["Urumqi, Xinjiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qiang","family":"Dong","sequence":"additional","affiliation":[{"name":"Department of Hepatic Laparoscopic Surgery, The First Affiliated Hospital of Xinjiang Medical University","place":["Urumqi, Xinjiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xinling","family":"Cao","sequence":"additional","affiliation":[{"name":"Department of Hepatic 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