Materiały źródłowe

• #1 Approaches to the Diagnosis and Grading of Hiatal Hernia

  https://pmc.ncbi.nlm.nih.gov/articles/PMC2548324/

  Hiatus hernia refers to conditions in which elements of the abdominal cavity, most commonly the stomach, herniate through the esophageal hiatus into the mediastinum. Sliding hiatus hernia is readily diagnosed by barium swallow radiography, endoscopy, or manometry when greater than 2 cm in axial span. […] Detecting lesser degrees of axial separation between the lower esophageal sphincter and crural diaphragm can only be reliably accomplished with high resolution manometry, a technique that permits real time localization of these esophagogastric junction components without swallow or distention related artifact. […] The major significance of type I hernias is in their association with reflux disease. […] The most common symptoms are epigastric or substernal pain, postprandial fullness, substernal fullness, nausea, and retching.

• #2 Hiatal hernia – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/hiatal-hernia/diagnosis-treatment/drc-20373385

  During an upper endoscopy, a healthcare professional inserts a thin, flexible tube equipped with a light and camera down the throat and into the esophagus. The tiny camera provides a view of the esophagus, stomach and the beginning of the small intestine, called the duodenum. […] A hiatal hernia is often discovered during a test or procedure to determine the cause of heartburn or pain in the chest or upper abdomen. These tests or procedures include: […] A procedure to look at the esophagus and stomach, called an endoscopy. Endoscopy is a procedure to examine your digestive system with a long, thin tube with a tiny camera, called an endoscope. The endoscope is passed down your throat and looks at the inside of your esophagus and stomach and checks for inflammation. […] A test to measure muscle contractions of the esophagus, called an esophageal manometry. This test measures the rhythmic muscle contractions in your esophagus when you swallow. Esophageal manometry also measures the coordination and force used by the muscles of your esophagus.

• #3 Hiatal hernia – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/hiatal-hernia/symptoms-causes/syc-20373379

  A hiatal hernia occurs when the upper part of the stomach bulges through the diaphragm into the chest cavity. […] A small hiatal hernia usually doesn’t cause problems. You may never know you have one unless your healthcare team discovers it when checking for another condition. […] But a large hiatal hernia can allow food and acid to back up into your esophagus. This can cause heartburn. Self-care measures or medicines can usually relieve these symptoms. A very large hiatal hernia might need surgery. […] Make an appointment with your doctor or other healthcare professional if you have any lasting symptoms that worry you.

• #4 Hiatus hernia | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/hiatus-hernia?lang=us

  Hiatus hernias (alternative plural: herniae) occur when there is herniation of abdominal contents through the esophageal hiatus of the diaphragm into the thoracic cavity. […] Many patients with hiatus hernia are asymptomatic, and it is an incidental finding. However, symptoms may include epigastric or chest pain, postprandial fullness, nausea and vomiting. […] Sometimes hiatus hernias are considered synonymous with gastro-esophageal reflux disease (GERD), but there is a poor correlation between the two conditions. […] In some institutions measurement of a hiatal surface area (HSA) has been proposed. […] Symptomatic hiatus hernias, especially types 2-4, should be managed surgically. […] The mere presence of a sliding hiatus hernia is of limited clinical significance in most cases. The function of the lower esophageal sphincter and the presence of pathologic gastro-esophageal reflux are the crucial factors in producing symptoms and causing complications.

• #5 Hiatal hernia – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/hiatal-hernia/diagnosis-treatment/drc-20373385

  During an upper endoscopy, a healthcare professional inserts a thin, flexible tube equipped with a light and camera down the throat and into the esophagus. The tiny camera provides a view of the esophagus, stomach and the beginning of the small intestine, called the duodenum. […] A hiatal hernia is often discovered during a test or procedure to determine the cause of heartburn or pain in the chest or upper abdomen. These tests or procedures include: […] A procedure to look at the esophagus and stomach, called an endoscopy. Endoscopy is a procedure to examine your digestive system with a long, thin tube with a tiny camera, called an endoscope. The endoscope is passed down your throat and looks at the inside of your esophagus and stomach and checks for inflammation. […] A test to measure muscle contractions of the esophagus, called an esophageal manometry. This test measures the rhythmic muscle contractions in your esophagus when you swallow. Esophageal manometry also measures the coordination and force used by the muscles of your esophagus.

• #6 Hiatal Hernia Workup: Approach Considerations, Imaging Studies, Procedures

  https://emedicine.medscape.com/article/178393-workup

  The typical reasons for evaluation are symptoms of GERD or a chest radiograph suggesting a paraesophageal hernia. […] A mass lesion in the central chest could be confused with a hiatal hernia. […] Although a chest radiograph may reveal a large hiatal hernia, and many incidentally diagnosed hiatal hernias are discovered in this manner, a barium study of the esophagus helps establish the diagnosis with greater accuracy. […] Typical findings include an outpouching of barium at the lower end of the esophagus, a wide hiatus through which gastric folds are seen in continuum with those in the stomach, and, occasionally, free reflux of barium. […] A barium study helps distinguish a sliding from a paraesophageal hernia. […] Hiatal hernia is diagnosed easily using upper gastrointestinal endoscopy.

• #7 Hiatal Hernia Imaging: Practice Essentials, Radiography, Computed Tomography

  https://emedicine.medscape.com/article/369510-overview

  Hiatal hernia (also called hiatus hernia and paraesophageal hernia) occurs when part of the stomach protrudes into the thoracic cavity through the esophageal hiatus of the diaphragm. […] Most hiatal hernias are found incidentally, and they are usually discovered on routine chest radiographs or computed tomography (CT) scans performed for unrelated symptoms. […] An upper GI barium series is the preferred examination in the investigation of suggested hiatal hernia and its sequelae. […] CT scans are useful when more precise cross-sectional anatomic localization is desired. […] Manometry studies have shown that it can be used to rule out motility disorders such as achalasia, which can mimic reflux. […] An upper GI barium series or barium swallow study is the examination of choice for depicting a hiatal hernia, gastroesophageal reflux, and any associated complications. […] CT scanning is not routinely used in the diagnosis of a hiatal hernia, but it may be useful for specific indications. […] Ultrasonography is a noninvasive technique that may be useful in the diagnosis of a hiatal hernia and gastroesophageal reflux.

• #8 Hiatal Hernia Causes and Diagnoses | Northwestern Medicine

  https://www.nm.org/conditions-and-care-areas/gastroenterology/hiatal-hernia/causes-and-diagnoses

  Diagnosing a hiatal hernia […] A hiatal hernia is often discovered during diagnostic or screening tests for other conditions. Those tests may include: […] Chest X-ray: This common X-ray image may show that you have a hiatal hernia. […] Fiberoptic endoscopy: An endoscope (a thin, lighted tube with a camera attached to it) is passed through your mouth and esophagus. Your physician can look at pictures of your digestive tract and determine if there is a hiatal hernia. […] Capsule endoscopy: A tiny camera, embedded in a small capsule that you swallow, takes pictures of your esophagus. […] Esophagram/barium swallow: A special series of X-rays is taken of your esophagus after you drink small amounts of a liquid containing barium, a contrast material that coats your esophagus and shows up well on X-rays. […] Pharyngeal manometry: A pressure-sensitive tube is passed through your nose and into your stomach to measure pressure inside your esophagus.

• #9 The management of hiatal hernia: an update on diagnosis and treatment

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6853045/

  Barium swallow radiography gives valuable information about the size of the herniated stomach and the location of the gastroesophageal junction. Most studies agree that barium swallow still remains essential in the diagnosis of hiatal hernia. […] Esophageal manometry provides valuable information regarding the motility of the esophagus. It is considered that a separation between the crural diaphragm and lower esophageal sphincter of 2 cm or more is diagnostic for hiatal hernia. […] The current guideline for the surgical treatment of hiatal hernia was elaborated by the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) in the year 2013. Through our literature research we have found that indications for surgery remain the same: symptomatic patients with paraesophageal hernia, especially those with obstructive symptoms and gastric volvulus, which require urgent surgery. […] The SAGES Guidelines strongly recommend not repairing type I hiatal hernia in the absence of reflux disease and symptoms; this recommendation remains valid to this day, as sustained by several authors.

• #10 Hiatal Hernia Workup: Approach Considerations, Imaging Studies, Procedures

  https://emedicine.medscape.com/article/178393-workup

  The typical reasons for evaluation are symptoms of GERD or a chest radiograph suggesting a paraesophageal hernia. […] A mass lesion in the central chest could be confused with a hiatal hernia. […] Although a chest radiograph may reveal a large hiatal hernia, and many incidentally diagnosed hiatal hernias are discovered in this manner, a barium study of the esophagus helps establish the diagnosis with greater accuracy. […] Typical findings include an outpouching of barium at the lower end of the esophagus, a wide hiatus through which gastric folds are seen in continuum with those in the stomach, and, occasionally, free reflux of barium. […] A barium study helps distinguish a sliding from a paraesophageal hernia. […] Hiatal hernia is diagnosed easily using upper gastrointestinal endoscopy.

• #11 Hiatal hernia – Wikipedia

  https://en.wikipedia.org/wiki/Hiatal_hernia

  The diagnosis of a hiatal hernia is typically made through an upper GI series, endoscopy, high resolution manometry, esophageal pH monitoring, and computed tomography (CT). […] Endoscopy can analyse the esophageal internal surface for erosions, ulcers, and tumours. […] The diagnosis may be confirmed with endoscopy or medical imaging. […] CT scan is useful in diagnosing complications of hiatal hernia such as gastric volvulus, perforation, pneumoperitoneum, and pneumomediastinum.

• #12 Esophageal Manometry: Understanding Hiatal Hernia Diagnosis – Dr. Adam S. Harris, M.D.

  https://surgeonadamharris.com/esophageal-manometry-hiatal-hernia-diagnosis/

  In addition to esophageal manometry, other diagnostic tests may be utilized to confirm or evaluate a hiatal hernia further. […] A barium swallow is a radiographic procedure where you swallow a liquid containing barium, which coats the esophagus and stomach. […] Barium swallow studies can reveal the presence, size, and sliding nature of a hiatal hernia. […] A computed tomography (CT) scan may be ordered to obtain detailed cross-sectional images of the esophagus, stomach, and surrounding structures. […] CT scans provide comprehensive views of the anatomy and can help evaluate the severity of a hiatal hernia, as well as detect any associated complications like volvulus, in which the stomach becomes twisted. […] Your doctor will review the results of your esophageal manometry and any other tests performed. […] They will explain what the findings mean in the context of your specific symptoms, and whether a hiatal hernia or any other condition has been identified.

• #13 Hiatal Hernia | General Surgery

  https://generalsurgery.ucsf.edu/condition/hiatal-hernia

  A hiatal hernia is the protrusion (or herniation) of the upper part of the stomach into the thorax through a tear or weakness in the diaphragm. […] The diagnosis is often made by endoscopy or medical imaging. […] Diagnosis of a hiatal hernia requires upper GI endoscopy, a barium swallow study, an MRI, or computerized tomography (CT) scan.

• #14 Optimal workup for a hiatal hernia – Laracca – Annals of Laparoscopic and Endoscopic Surgery

  https://ales.amegroups.org/article/view/5911/html

  Elective patients suspected for Hiatal Hernia are primarily examined for history of previous surgery, especially upper GI surgery, and comorbidities. Then a thorough analysis of signs and symptoms is mandatory. […] All patients with suspected or confirmed symptomatic hiatal hernia should undergo an esophagogastroduodenoscopy (EGD); however, given the diffusion of endoscopy, hiatal hernias are frequently diagnosed when endoscopy has been already performed for other symptoms and/or reasons. Endoscopy helps defining the anatomy, the size and type of the hernia, any associated esophageal and gastric mucosal disease such as esophagitis, Barretts esophagus and cancer. […] A hiatal hernia is diagnosed by EGD evaluating the distance between the EGJ and the diaphragmatic incisura, which is the impression of the diaphragmatic hiatus on the gastric wall. The endoscopic hiatal hernia diagnosis is defined as a distance greater than 2 cm.

• #15 Hiatal hernia – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/hiatal-hernia/diagnosis-treatment/drc-20373385

  During an upper endoscopy, a healthcare professional inserts a thin, flexible tube equipped with a light and camera down the throat and into the esophagus. The tiny camera provides a view of the esophagus, stomach and the beginning of the small intestine, called the duodenum. […] A hiatal hernia is often discovered during a test or procedure to determine the cause of heartburn or pain in the chest or upper abdomen. These tests or procedures include: […] A procedure to look at the esophagus and stomach, called an endoscopy. Endoscopy is a procedure to examine your digestive system with a long, thin tube with a tiny camera, called an endoscope. The endoscope is passed down your throat and looks at the inside of your esophagus and stomach and checks for inflammation. […] A test to measure muscle contractions of the esophagus, called an esophageal manometry. This test measures the rhythmic muscle contractions in your esophagus when you swallow. Esophageal manometry also measures the coordination and force used by the muscles of your esophagus.

• #16 Approaches to the Diagnosis and Grading of Hiatal Hernia

  https://pmc.ncbi.nlm.nih.gov/articles/PMC2548324/

  The radiographic demonstration of a sliding hiatus hernia is usually done in the setting of a barium swallow examination. […] Recognition of this confounding effect led to the 2 cm rule wherein there must be more than 2 cm separation between the B ring and the diaphragmatic hiatus before being considered a sliding hiatus hernia. […] Sliding hiatus hernia is diagnosed when the apparent separation between the squamocolumnar junction and the diaphragmatic impression is greater than 2 cm as measured using the hash marks on the endoscope. […] High resolution manometry objectifies the assessment of sliding hiatus hernia. For the first time, it offers a means to complete the continuum from normal to overt sliding hernia by detecting intermediate grades of EGJ disruption.

• #17 Optimal workup for a hiatal hernia – Laracca – Annals of Laparoscopic and Endoscopic Surgery

  https://ales.amegroups.org/article/view/5911/html

  Elective patients suspected for Hiatal Hernia are primarily examined for history of previous surgery, especially upper GI surgery, and comorbidities. Then a thorough analysis of signs and symptoms is mandatory. […] All patients with suspected or confirmed symptomatic hiatal hernia should undergo an esophagogastroduodenoscopy (EGD); however, given the diffusion of endoscopy, hiatal hernias are frequently diagnosed when endoscopy has been already performed for other symptoms and/or reasons. Endoscopy helps defining the anatomy, the size and type of the hernia, any associated esophageal and gastric mucosal disease such as esophagitis, Barretts esophagus and cancer. […] A hiatal hernia is diagnosed by EGD evaluating the distance between the EGJ and the diaphragmatic incisura, which is the impression of the diaphragmatic hiatus on the gastric wall. The endoscopic hiatal hernia diagnosis is defined as a distance greater than 2 cm.

• #18 Hiatal Hernia Workup: Approach Considerations, Imaging Studies, Procedures

  https://emedicine.medscape.com/article/178393-workup

  The diagnosis of a hiatal hernia actually is incidental, and endoscopy is used to diagnose complications such as erosive esophagitis, ulcers in the hiatal hernia, Barrett esophagus, or tumor. […] A hiatal hernia is confirmed when the endoscope is about to enter the stomach or on retrograde view once inside the stomach. […] Traditionally, esophageal manometry has had a low sensitivity for diagnosing hiatal hernia, as compared to endoscopy, and was therefore not appropriate in helping to establish a diagnosis. […] More recent studies with esophageal high-resolution manometry (HRM) appear to be more accurate for detecting hiatal hernias.

• #19 Clinical Significance of Hiatal Hernia

  https://www.gutnliver.org/journal/view.html?pn=vol&uid=284&vmd=Full

  The diagnosis of hiatal hernia can be made through radiographic, endoscopic, and manometric assessment. Whereas large hiatal hernias can be detected and diagnosed without difficulty using either of these methods, diagnosing small hiatal hernias (2 cm) can be challenging with each modality having its limitations. […] The limitation of this method is that it is not always possible to detect all the landmarks of the phrenic ampulla. Defining hiatal hernia especially becomes problematic when the „B” ring, marker necessary for defining the presence of hiatal hernia that is only detectable in about 15% of subjects, cannot be identified. In the absence of the „B” ring, the result of barium contrast studies to diagnose hiatal hernia can become quite inconsistent. […] The use of endoscopy has become widespread over the past few decades and is now considered the standard modality for diagnosing and treating diseases of the upper gastrointestinal tract. Although barium contrast study has been the most commonly applied method for diagnosing hiatal hernia worldwide, hiatal hernia is increasingly diagnosed with endoscopy.

• #20 Hiatal Hernia | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/22859

  Hiatal hernias can cause symptoms such as heartburn, regurgitation, and difficulty swallowing. […] The preoperative workup in a patient being considered for operative treatment will help confirm the diagnosis, exclude other pathologic entities, and direct the operative intervention. Endoscopy is an essential step in evaluating GERD and a suspected hiatal hernia in patients being considered for surgery. […] The 24-hour pH test is the gold standard for diagnosing acid reflux. […] The management of hiatal hernias depends on the type of hernia and the severity of the symptoms. […] The indications for surgical therapy have changed since the advent of PPIs. […] The Nissen fundoplication (360 wrap) involves completely wrapping the GEJ using the stomach fundus. […] Advances in minimally invasive surgery have led to the widespread acceptance of laparoscopic hernia repair.

• #21 Approaches to the Diagnosis and Grading of Hiatal Hernia

  https://pmc.ncbi.nlm.nih.gov/articles/PMC2548324/

  The radiographic demonstration of a sliding hiatus hernia is usually done in the setting of a barium swallow examination. […] Recognition of this confounding effect led to the 2 cm rule wherein there must be more than 2 cm separation between the B ring and the diaphragmatic hiatus before being considered a sliding hiatus hernia. […] Sliding hiatus hernia is diagnosed when the apparent separation between the squamocolumnar junction and the diaphragmatic impression is greater than 2 cm as measured using the hash marks on the endoscope. […] High resolution manometry objectifies the assessment of sliding hiatus hernia. For the first time, it offers a means to complete the continuum from normal to overt sliding hernia by detecting intermediate grades of EGJ disruption.

• #22 Optimal workup for a hiatal hernia – Laracca – Annals of Laparoscopic and Endoscopic Surgery

  https://ales.amegroups.org/article/view/5911/html

  In our institution whenever possible we study all the patients scheduled for a hiatal hernia repair with a high resolution manometry (HRM); this exam provides important details about the motility of the esophagus and the EGJ. […] HRM can help to tune the operative strategy since findings of severe dysmotility or pseudoachalasia may indicate a simple hiatal repair without fundoplication. […] The work-up is similar to the non-recurrent patients. […] Patients symptoms, clinical presentations and hiatal hernia type drive the selection of the most appropriate workup for hiatal hernia. For elective HH repair we advocate the use of UGI series, EGD and HRM as first line pre-operative tests. More specific functional and morphological studies such as pH testing, PTF, and CT scan should be used case by case depending on the hernia size, patients symptoms and setting.

• #23 Paraesophageal (Hiatal) Hernia Diagnosis & Treatment | AHN

  https://www.ahn.org/services/esophageal/conditions/paraesophageal-hernia

  Sedated or unsedated endoscopy with biopsy collection is routinely performed in order to visualize your esophagus and stomach to look for the presence of hernia and screen for Barretts esophagus. […] pH acid monitoring is a disposable capsule placed into your esophagus using an endoscope. It wirelessly transmits information about esophageal acid levels to a receiver worn around your waist for 48 hours. […] High resolution manometry measures the strength, pressure and coordination of your esophagus’ muscles. A specially trained nurse guides a small catheter through your nose and into the esophagus and instructs you to swallow small amounts of liquid at specific intervals. […] A 24-hour impedance catheter is used to measure the reflux of fluid and gauge its proximity to your voice box. This test is typically used for patients who are experiencing cough, respiratory or non-classical GERD symptoms. A small catheter is inserted through your nose and records data in receiver worn around your waist during while you conduct your regular daily activities.

• #24

  https://www.aurorahealthcare.org/services/gastroenterology-colorectal-surgery/hiatus-hernia-hiatal-hernia

  To diagnose a hiatal hernia, your doctor will perform a physical exam. They’ll talk to you about your medical history and possible symptoms of hiatal hernia. […] Consultation with a pulmonologist may be needed to help rule out other chest and lung conditions. Tests may be performed, including: Upper GI endoscopy: A flexible tube equipped with a light and tiny camera (endoscope) is inserted down your throat to see inside the esophagus and stomach. If needed, a tissue sample (biopsy) can be done during an endoscopy. These samples are examined in a lab to check for problems. […] pH monitoring: This test checks for stomach acid in your esophagus. […] Motility testing (esophageal manometry): This test measures if the esophagus is working properly. A thin, flexible tube (catheter) is inserted into your nose, down the esophagus and into the stomach. […] Barium swallow: You’ll drink a liquid that contains barium (a silver-white metallic compound). The barium coats your esophagus and stomach and will show up on fluoroscopic X-rays taken at rest and while you swallow. This test is also known as an esophagogram or an upper GI series.

• #25 Paraesophageal (Hiatal) Hernia Diagnosis & Treatment | AHN

  https://www.ahn.org/services/esophageal/conditions/paraesophageal-hernia

  Sedated or unsedated endoscopy with biopsy collection is routinely performed in order to visualize your esophagus and stomach to look for the presence of hernia and screen for Barretts esophagus. […] pH acid monitoring is a disposable capsule placed into your esophagus using an endoscope. It wirelessly transmits information about esophageal acid levels to a receiver worn around your waist for 48 hours. […] High resolution manometry measures the strength, pressure and coordination of your esophagus’ muscles. A specially trained nurse guides a small catheter through your nose and into the esophagus and instructs you to swallow small amounts of liquid at specific intervals. […] A 24-hour impedance catheter is used to measure the reflux of fluid and gauge its proximity to your voice box. This test is typically used for patients who are experiencing cough, respiratory or non-classical GERD symptoms. A small catheter is inserted through your nose and records data in receiver worn around your waist during while you conduct your regular daily activities.

• #26 Hiatal Hernia | Hackensack Meridian Health

  https://www.hackensackmeridianhealth.org/en/services/gastroenterology-and-nutrition/hiatal-hernia

  Several tests can be done to help diagnose a hiatal hernia. A hiatal hernia is often discovered during a test or procedure to determine the cause of heartburn or chest or upper abdominal pain. These tests or procedures include: […] X-rays (barium swallow test) […] CT scan […] Endoscopy […] Esophageal manometry test […] Gastric emptying studies.

• #27 What Is a Hiatal Hernia? Symptoms, Causes, Diagnosis, Treatment, and Prevention

  https://www.everydayhealth.com/hiatal-hernia/guide/

  To diagnose a hiatal hernia, your doctor will first ask you about your symptoms and perform a physical exam. […] If you’re experiencing frequent heartburn or chest or abdominal pain, your doctor will probably order tests to look for the cause of your symptoms. These tests may include: […] After drinking a chalky liquid containing barium, you’ll undergo an X-ray which allows your doctor to see the outline of your upper digestive tract. If you have a hiatal hernia, this test will let your doctor see its size and whether there’s any twisting of your stomach a potentially serious complication. […] In this test, your doctor will insert a thin, flexible tube containing a light and tiny camera into your throat and slide it down your esophagus into your stomach. […] This test measures muscle contractions in your esophagus when you swallow to assess its strength and muscle coordination. […] A pH test measures the acid levels in your esophagus and can help determine whether your symptoms are related to acid reflux. […] If you’re experiencing severe symptoms like nausea and vomiting, testing how quickly food leaves your stomach can help identify causes other than a hiatal hernia.

• #28 Hiatal Hernia: Test and Diagnosis

  https://www.verywellhealth.com/diagnosing-hiatal-hernias-1742604

  Esophageal pH monitoring is a test used to record changes in the acidity of your esophagus over a period of time (as measured by the pH). […] Once a hiatal hernia is diagnosed, it is classified by type, which can help direct treatment and/or be used to monitor any changes in your condition. […] While you might want to check yourself for hiatal hernia, imagine tests are almost always needed to make a diagnosis. […] A healthcare provider will classify the type, perform a differential diagnosis to exclude other causes, and then discuss a treatment option.

• #29 Approaches to the Diagnosis and Grading of Hiatal Hernia

  https://pmc.ncbi.nlm.nih.gov/articles/PMC2548324/

  Hiatus hernia refers to conditions in which elements of the abdominal cavity, most commonly the stomach, herniate through the esophageal hiatus into the mediastinum. Sliding hiatus hernia is readily diagnosed by barium swallow radiography, endoscopy, or manometry when greater than 2 cm in axial span. […] Detecting lesser degrees of axial separation between the lower esophageal sphincter and crural diaphragm can only be reliably accomplished with high resolution manometry, a technique that permits real time localization of these esophagogastric junction components without swallow or distention related artifact. […] The major significance of type I hernias is in their association with reflux disease. […] The most common symptoms are epigastric or substernal pain, postprandial fullness, substernal fullness, nausea, and retching.

• #30 Approaches to the Diagnosis and Grading of Hiatal Hernia

  https://pmc.ncbi.nlm.nih.gov/articles/PMC2548324/

  An upright radiograph of the thorax may be diagnostic, revealing a retrocardiac air-fluid level within a paraesophageal hernia or intrathoracic stomach. […] Barium contrast studies are almost always diagnostic and attention should focus on the position of the EGJ in order to differentiate type II and III hernias. […] The natural history of a type II hernia is progressive enlargement so that the entire stomach eventually herniates, with the pylorus juxtaposed to the gastric cardia, forming an upside-down, intrathoracic stomach. […] The definition of a type I hiatus hernia is dependent on the anatomic relationship of the distal esophagus, hiatus, and stomach. […] Physiological herniation occurs during primary peristalsis, secondary peristalsis, esophageal distention, and transient LES relaxation since in each case the gastric cardia tents through the diaphragmatic hiatus.

• #31 Approaches to the Diagnosis and Grading of Hiatal Hernia

  https://pmc.ncbi.nlm.nih.gov/articles/PMC2548324/

  An upright radiograph of the thorax may be diagnostic, revealing a retrocardiac air-fluid level within a paraesophageal hernia or intrathoracic stomach. […] Barium contrast studies are almost always diagnostic and attention should focus on the position of the EGJ in order to differentiate type II and III hernias. […] The natural history of a type II hernia is progressive enlargement so that the entire stomach eventually herniates, with the pylorus juxtaposed to the gastric cardia, forming an upside-down, intrathoracic stomach. […] The definition of a type I hiatus hernia is dependent on the anatomic relationship of the distal esophagus, hiatus, and stomach. […] Physiological herniation occurs during primary peristalsis, secondary peristalsis, esophageal distention, and transient LES relaxation since in each case the gastric cardia tents through the diaphragmatic hiatus.

• #32 Hiatal Hernia Workup: Approach Considerations, Imaging Studies, Procedures

  https://emedicine.medscape.com/article/178393-workup

  The typical reasons for evaluation are symptoms of GERD or a chest radiograph suggesting a paraesophageal hernia. […] A mass lesion in the central chest could be confused with a hiatal hernia. […] Although a chest radiograph may reveal a large hiatal hernia, and many incidentally diagnosed hiatal hernias are discovered in this manner, a barium study of the esophagus helps establish the diagnosis with greater accuracy. […] Typical findings include an outpouching of barium at the lower end of the esophagus, a wide hiatus through which gastric folds are seen in continuum with those in the stomach, and, occasionally, free reflux of barium. […] A barium study helps distinguish a sliding from a paraesophageal hernia. […] Hiatal hernia is diagnosed easily using upper gastrointestinal endoscopy.

• #33 Hiatus hernia | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/hiatus-hernia?lang=us

  Hiatus hernias (alternative plural: herniae) occur when there is herniation of abdominal contents through the esophageal hiatus of the diaphragm into the thoracic cavity. […] Many patients with hiatus hernia are asymptomatic, and it is an incidental finding. However, symptoms may include epigastric or chest pain, postprandial fullness, nausea and vomiting. […] Sometimes hiatus hernias are considered synonymous with gastro-esophageal reflux disease (GERD), but there is a poor correlation between the two conditions. […] In some institutions measurement of a hiatal surface area (HSA) has been proposed. […] Symptomatic hiatus hernias, especially types 2-4, should be managed surgically. […] The mere presence of a sliding hiatus hernia is of limited clinical significance in most cases. The function of the lower esophageal sphincter and the presence of pathologic gastro-esophageal reflux are the crucial factors in producing symptoms and causing complications.

• #34 The management of hiatal hernia: an update on diagnosis and treatment

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6853045/

  Barium swallow radiography gives valuable information about the size of the herniated stomach and the location of the gastroesophageal junction. Most studies agree that barium swallow still remains essential in the diagnosis of hiatal hernia. […] Esophageal manometry provides valuable information regarding the motility of the esophagus. It is considered that a separation between the crural diaphragm and lower esophageal sphincter of 2 cm or more is diagnostic for hiatal hernia. […] The current guideline for the surgical treatment of hiatal hernia was elaborated by the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) in the year 2013. Through our literature research we have found that indications for surgery remain the same: symptomatic patients with paraesophageal hernia, especially those with obstructive symptoms and gastric volvulus, which require urgent surgery. […] The SAGES Guidelines strongly recommend not repairing type I hiatal hernia in the absence of reflux disease and symptoms; this recommendation remains valid to this day, as sustained by several authors.

• #35 Hiatal Hernia | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/22859

  The differential diagnosis of GERD can be quite extensive, thus the thorough workup before operative therapy. […] The success of hiatal hernia surgery can be measured by evaluating symptom relief, improvement in esophageal acid exposure, the incidence of complications, and the need for reoperation. […] Preventing a hiatal hernia involves measures that reduce intraabdominal pressure, such as maintaining a healthy weight, avoiding heavy lifting, and practicing good posture. […] Managing hiatal hernias and reflux requires an interprofessional team approach.

• #36 Hiatal Hernia: Misdiagnosed & Misunderstood

  https://www.drmalladi.com/misdiagnosed-hiatal-hernia/

  Even the best doctors can make diagnostic mistakes. If the doctor asks the wrong questions or performs the wrong tests, a misdiagnosis of a hiatal hernia can easily occur, and this condition can easily be mistaken for something else. […] A misdiagnosis occurs when your doctor mistakes the symptoms of a hernia for those of some other condition. With a hiatal hernia, this can occur fairly easily since the following conditions show similar symptoms: […] In order for a proper diagnosis to be made, the doctor must ask the right questions, and then perform the right tests. For instance, Dr. Malladi can perform an upper endoscopy which uses a small camera to determine if a hiatal hernia has occurred. This can save a great deal of trouble and prevent a misdiagnosis, ultimately resulting in faster relief from symptoms.

• #37 Hiatal Hernia: Misdiagnosed & Misunderstood

  https://www.drmalladi.com/misdiagnosed-hiatal-hernia/

  Even the best doctors can make diagnostic mistakes. If the doctor asks the wrong questions or performs the wrong tests, a misdiagnosis of a hiatal hernia can easily occur, and this condition can easily be mistaken for something else. […] A misdiagnosis occurs when your doctor mistakes the symptoms of a hernia for those of some other condition. With a hiatal hernia, this can occur fairly easily since the following conditions show similar symptoms: […] In order for a proper diagnosis to be made, the doctor must ask the right questions, and then perform the right tests. For instance, Dr. Malladi can perform an upper endoscopy which uses a small camera to determine if a hiatal hernia has occurred. This can save a great deal of trouble and prevent a misdiagnosis, ultimately resulting in faster relief from symptoms.

• #38 The management of hiatal hernia: an update on diagnosis and treatment

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6853045/

  Hiatal hernia (HH) occurs quite frequently in the general population and is characterized by a wide range of non-specific symptoms, most of them related to gastroesophageal reflux disease. […] This narrative review presents new data on the diagnosis and management of hiatal hernia. While the diagnostic pathway has remained virtually unchanged, new data have come to light regarding the surgical treatment of hiatal hernia. We present the imaging methods used for its diagnosis, as well as the medical and surgical treatment currently available. […] According to the Society of American Gastrointestinal and Endoscopic Surgeons, only investigations that will have an impact on the clinical management of the patient should be performed. The diagnosis of hiatal hernia can be rather challenging at times due to the shift in the anatomy of the esophagogastric junction during deglutition, respiration and movement. A complete history and physical exam is mandatory, as they may reveal symptoms that were not previously apparent.

• #39 How Do I Check Myself for a Hiatal Hernia? Signs, Getting Help

  https://www.healthline.com/health/how-do-i-check-myself-for-a-hiatal-hernia

  A hiatal hernia cannot be self-diagnosed with a physical exam and may be potentially dangerous. […] Instead, you should see a doctor if you experience symptoms of a hiatal hernia, such as indigestion, acid reflux, swallowing difficulties, frequent vomiting, unexplained weight loss, or upper abdominal pain. […] A doctor will perform several tests to make a diagnosis, such as a physical exam, imaging tests, or a barium swallow radiography test. […] Doctors may use different tests to check if you have a hiatal hernia, but its not possible to self-diagnose with a physical exam. […] Its not possible to check yourself for a hiatal hernia, and you may not be aware that you have the condition, as symptoms do not always appear. […] Its recommended you see a doctor if you have symptoms of hiatal hernia or your symptoms have not improved with treatment.

• #40 Hiatal hernia – Symptoms, diagnosis and treatment | BMJ Best Practice US

  https://bestpractice.bmj.com/topics/en-us/735

  Hiatal hernia may be asymptomatic or may present with heartburn, dysphagia, odynophagia, hoarseness, asthma, shortness of breath, chest pain, anemia or hematemesis, or a combination of these. […] An upper gastrointestinal fluoroscopy with oral contrast is the key investigation technique and aids the surgeon in characterizing any anatomic variation necessary for preoperative evaluation. Computed tomography scanning with 3-dimensional reconstruction can be helpful if the diagnosis is unclear, or when planning surgery. […] The necessity for, and type of treatment, depends on the patient’s symptoms and the anatomic configuration of the hernia. […] Uncomplicated sliding hiatal hernias are treated symptomatically with medical therapy, although some patients may select surgical therapy. Complicated hiatal hernias (those with bleeding, volvulus, or obstruction) have a stronger indication for surgical repair.

• #41 Hiatal Hernia Workup: Approach Considerations, Imaging Studies, Procedures

  https://emedicine.medscape.com/article/178393-workup

  The typical reasons for evaluation are symptoms of GERD or a chest radiograph suggesting a paraesophageal hernia. […] A mass lesion in the central chest could be confused with a hiatal hernia. […] Although a chest radiograph may reveal a large hiatal hernia, and many incidentally diagnosed hiatal hernias are discovered in this manner, a barium study of the esophagus helps establish the diagnosis with greater accuracy. […] Typical findings include an outpouching of barium at the lower end of the esophagus, a wide hiatus through which gastric folds are seen in continuum with those in the stomach, and, occasionally, free reflux of barium. […] A barium study helps distinguish a sliding from a paraesophageal hernia. […] Hiatal hernia is diagnosed easily using upper gastrointestinal endoscopy.

• #42 Hiatus Hernia: Symptom & Diagnosis by Best Hernia Specialist

  https://anandgastrosurgeon.com/hernia-symptoms-guided-by-hernia-specialist/

  A hiatus hernia happens when the upper part of your stomach pushes through an opening in your diaphragm into your chest. […] However, a larger hiatus hernia can cause food and stomach acid to back up into the esophagus, leading to heartburn. […] If you have a sliding hiatus hernia, which is the most common type, you likely wont feel the hernia itself or see a bulge on the outside. […] Not everyone with a hiatus hernia has acid reflux, and not everyone with acid reflux has a hiatus hernia. […] If you experience any of the following symptoms, its important to consult a hernia specialist: Severe or Persistent Symptoms: Persistent heartburn, chest pain, or difficulty swallowing that doesnt improve with over-the-counter medications or lifestyle changes. […] Seeing a hernia specialist ensures you receive a proper diagnosis and effective treatment plan, preventing complications and improving your overall well-being.

• #43 Hiatal hernia – Symptoms, diagnosis and treatment | BMJ Best Practice US

  https://bestpractice.bmj.com/topics/en-us/735

  Hiatal hernia may be asymptomatic or may present with heartburn, dysphagia, odynophagia, hoarseness, asthma, shortness of breath, chest pain, anemia or hematemesis, or a combination of these. […] An upper gastrointestinal fluoroscopy with oral contrast is the key investigation technique and aids the surgeon in characterizing any anatomic variation necessary for preoperative evaluation. Computed tomography scanning with 3-dimensional reconstruction can be helpful if the diagnosis is unclear, or when planning surgery. […] The necessity for, and type of treatment, depends on the patient’s symptoms and the anatomic configuration of the hernia. […] Uncomplicated sliding hiatal hernias are treated symptomatically with medical therapy, although some patients may select surgical therapy. Complicated hiatal hernias (those with bleeding, volvulus, or obstruction) have a stronger indication for surgical repair.

• #44 Hiatal hernia – Symptoms, diagnosis and treatment | BMJ Best Practice US

  https://bestpractice.bmj.com/topics/en-us/735

  Hiatal hernia may be asymptomatic or may present with heartburn, dysphagia, odynophagia, hoarseness, asthma, shortness of breath, chest pain, anemia or hematemesis, or a combination of these. […] An upper gastrointestinal fluoroscopy with oral contrast is the key investigation technique and aids the surgeon in characterizing any anatomic variation necessary for preoperative evaluation. Computed tomography scanning with 3-dimensional reconstruction can be helpful if the diagnosis is unclear, or when planning surgery. […] The necessity for, and type of treatment, depends on the patient’s symptoms and the anatomic configuration of the hernia. […] Uncomplicated sliding hiatal hernias are treated symptomatically with medical therapy, although some patients may select surgical therapy. Complicated hiatal hernias (those with bleeding, volvulus, or obstruction) have a stronger indication for surgical repair.

• #45 Hiatal hernia – Symptoms, diagnosis and treatment | BMJ Best Practice US

  https://bestpractice.bmj.com/topics/en-us/735

  Key diagnostic factors include bowel sounds in chest. […] Other diagnostic factors include heartburn, regurgitation, obesity, chest pain, dysphagia, odynophagia, hematemesis, shortness of breath, cough, oropharyngitis, wheezing, nonbilious vomiting, fever and chills, and confusion. […] 1st tests to order include chest x-ray and upper gastrointestinal fluoroscopy with oral contrast. […] Tests to consider include esophago-gastro-duodenoscopy, CT scan or MRI scan, and high-resolution esophageal manometry and pH monitoring.

• #46 Hiatal hernia – Wikipedia

  https://en.wikipedia.org/wiki/Hiatal_hernia

  The diagnosis of a hiatal hernia is typically made through an upper GI series, endoscopy, high resolution manometry, esophageal pH monitoring, and computed tomography (CT). […] Endoscopy can analyse the esophageal internal surface for erosions, ulcers, and tumours. […] The diagnosis may be confirmed with endoscopy or medical imaging. […] CT scan is useful in diagnosing complications of hiatal hernia such as gastric volvulus, perforation, pneumoperitoneum, and pneumomediastinum.

• #47 The diagnosis and management of hiatus hernia | The BMJ

  https://www.bmj.com/content/349/bmj.g6154

  Hiatus hernia refers to herniation of the contents of the abdominal cavity, most commonly the stomach, through the esophageal hiatus of the diaphragm into the mediastinum. […] In the absence of symptoms, there is no indication to diagnose or treat hiatus hernia. […] Endoscopy, radiology with barium swallow, or high resolution manometry can detect most cases of hiatus hernia. […] This clinical review summarises the current evidence for the diagnosis and management of hiatus hernia.

• #48 Optimal workup for a hiatal hernia – Laracca – Annals of Laparoscopic and Endoscopic Surgery

  https://ales.amegroups.org/article/view/5911/html

  In our institution whenever possible we study all the patients scheduled for a hiatal hernia repair with a high resolution manometry (HRM); this exam provides important details about the motility of the esophagus and the EGJ. […] HRM can help to tune the operative strategy since findings of severe dysmotility or pseudoachalasia may indicate a simple hiatal repair without fundoplication. […] The work-up is similar to the non-recurrent patients. […] Patients symptoms, clinical presentations and hiatal hernia type drive the selection of the most appropriate workup for hiatal hernia. For elective HH repair we advocate the use of UGI series, EGD and HRM as first line pre-operative tests. More specific functional and morphological studies such as pH testing, PTF, and CT scan should be used case by case depending on the hernia size, patients symptoms and setting.

• #49 Hiatal Hernia | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/22859

  Hiatal hernias can cause symptoms such as heartburn, regurgitation, and difficulty swallowing. […] The preoperative workup in a patient being considered for operative treatment will help confirm the diagnosis, exclude other pathologic entities, and direct the operative intervention. Endoscopy is an essential step in evaluating GERD and a suspected hiatal hernia in patients being considered for surgery. […] The 24-hour pH test is the gold standard for diagnosing acid reflux. […] The management of hiatal hernias depends on the type of hernia and the severity of the symptoms. […] The indications for surgical therapy have changed since the advent of PPIs. […] The Nissen fundoplication (360 wrap) involves completely wrapping the GEJ using the stomach fundus. […] Advances in minimally invasive surgery have led to the widespread acceptance of laparoscopic hernia repair.

• #50 The management of hiatal hernia: an update on diagnosis and treatment

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6853045/

  Barium swallow radiography gives valuable information about the size of the herniated stomach and the location of the gastroesophageal junction. Most studies agree that barium swallow still remains essential in the diagnosis of hiatal hernia. […] Esophageal manometry provides valuable information regarding the motility of the esophagus. It is considered that a separation between the crural diaphragm and lower esophageal sphincter of 2 cm or more is diagnostic for hiatal hernia. […] The current guideline for the surgical treatment of hiatal hernia was elaborated by the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) in the year 2013. Through our literature research we have found that indications for surgery remain the same: symptomatic patients with paraesophageal hernia, especially those with obstructive symptoms and gastric volvulus, which require urgent surgery. […] The SAGES Guidelines strongly recommend not repairing type I hiatal hernia in the absence of reflux disease and symptoms; this recommendation remains valid to this day, as sustained by several authors.

• #51 Optimal workup for a hiatal hernia – Laracca – Annals of Laparoscopic and Endoscopic Surgery

  https://ales.amegroups.org/article/view/5911/html

  In our institution whenever possible we study all the patients scheduled for a hiatal hernia repair with a high resolution manometry (HRM); this exam provides important details about the motility of the esophagus and the EGJ. […] HRM can help to tune the operative strategy since findings of severe dysmotility or pseudoachalasia may indicate a simple hiatal repair without fundoplication. […] The work-up is similar to the non-recurrent patients. […] Patients symptoms, clinical presentations and hiatal hernia type drive the selection of the most appropriate workup for hiatal hernia. For elective HH repair we advocate the use of UGI series, EGD and HRM as first line pre-operative tests. More specific functional and morphological studies such as pH testing, PTF, and CT scan should be used case by case depending on the hernia size, patients symptoms and setting.

• #52 Hiatus Hernia – Rolling – Sliding – Management – TeachMeSurgery

  https://teachmesurgery.com/general/gastric/hiatus-hernia/

  The majority of cases are diagnosed on upper GI endoscopy (OGD), as the most common symptom is reflux or epigastric pain. OGD can show an upward displacement of the GOJ (Fig. 4, also termed the Z-line), as well as any oesophagitis, gastritis, or Barretts oesophagus present (and exclude any malignancy). […] Many hiatus hernia are often diagnosed incidentally, typically on CT imaging. However, if the hiatus hernia is asymptomatic with no significant features on imaging, then no further investigations are usually required. […] For patients being considered for surgical management (discussed below), further investigations are often required: Oesophageal manometry measures the pressure within the oesophagus during swallowing, useful for assessment of oesophageal motility disorders, such as achalasia; Ambulatory 24-hour oesophageal pH monitoring quantifies the level of reflux and assess the relationship between the reflux episodes and patient symptoms; Contrast swallow or meal can be used to diagnose a hiatus hernia and rule out other structural disorders such as strictures or motility disorders.

• #53 Hiatal hernia – Symptoms, diagnosis and treatment | BMJ Best Practice US

  https://bestpractice.bmj.com/topics/en-us/735

  Key diagnostic factors include bowel sounds in chest. […] Other diagnostic factors include heartburn, regurgitation, obesity, chest pain, dysphagia, odynophagia, hematemesis, shortness of breath, cough, oropharyngitis, wheezing, nonbilious vomiting, fever and chills, and confusion. […] 1st tests to order include chest x-ray and upper gastrointestinal fluoroscopy with oral contrast. […] Tests to consider include esophago-gastro-duodenoscopy, CT scan or MRI scan, and high-resolution esophageal manometry and pH monitoring.

• #54 Optimal workup for a hiatal hernia – Laracca – Annals of Laparoscopic and Endoscopic Surgery

  https://ales.amegroups.org/article/view/5911/html

  In our institution whenever possible we study all the patients scheduled for a hiatal hernia repair with a high resolution manometry (HRM); this exam provides important details about the motility of the esophagus and the EGJ. […] HRM can help to tune the operative strategy since findings of severe dysmotility or pseudoachalasia may indicate a simple hiatal repair without fundoplication. […] The work-up is similar to the non-recurrent patients. […] Patients symptoms, clinical presentations and hiatal hernia type drive the selection of the most appropriate workup for hiatal hernia. For elective HH repair we advocate the use of UGI series, EGD and HRM as first line pre-operative tests. More specific functional and morphological studies such as pH testing, PTF, and CT scan should be used case by case depending on the hernia size, patients symptoms and setting.

• #55 Optimal workup for a hiatal hernia – Laracca – Annals of Laparoscopic and Endoscopic Surgery

  https://ales.amegroups.org/article/view/5911/html

  Hiatal hernias are common and generally correlated with obesity and increasing age. However, many individuals have no symptoms and are never diagnosed, thus its hard to establish the real prevalence of hiatal hernias. To pursue a diagnosis of hiatal hernia is not necessary in asymptomatic patients, but symptomatic ones need evaluation and should be considered for surgical repair. The clinical workup is based on the patient’s symptomatology and clinical presentation. For elective HH repair we advocate the use of few standard pre-operative tests as first line. More specific functional and morphological studies scan should be used case by case depending on the hernia size, patients symptoms and setting. […] The optimal work up changes depending on patients history and clinical presentation.

• #56 Hiatal hernia – Symptoms, diagnosis and treatment | BMJ Best Practice US

  https://bestpractice.bmj.com/topics/en-us/735

  Key diagnostic factors include bowel sounds in chest. […] Other diagnostic factors include heartburn, regurgitation, obesity, chest pain, dysphagia, odynophagia, hematemesis, shortness of breath, cough, oropharyngitis, wheezing, nonbilious vomiting, fever and chills, and confusion. […] 1st tests to order include chest x-ray and upper gastrointestinal fluoroscopy with oral contrast. […] Tests to consider include esophago-gastro-duodenoscopy, CT scan or MRI scan, and high-resolution esophageal manometry and pH monitoring.

• #57 Clinical Significance of Hiatal Hernia

  https://www.gutnliver.org/journal/view.html?pn=vol&uid=284&vmd=Full

  Esophageal manometry measures intraluminal pressures and coordinated contractile movements of the esophageal musculature. Therefore, it is most commonly applied for assessing peristaltic function of the esophagus and measuring the LES pressure and relaxation, thus aiding in the evaluation of esophageal motility disorders. Although esophageal manometry is generally not indicated and plays a minimal role in diagnosing GERD, it can be used for establishing the presence of a hiatal hernia. […] High resolution manometry seems to hold the key to future studies on hiatal hernia and it is beckoning us to cast the probe deep into the esophagus. With the help of this magnificent apparatus that enables simultaneous luminal pressure monitoring and pressure topography plotting of the entire esophagus from the pharynx to the stomach in real-time, the clinical significance of hiatal hernias measuring less than 2 cm in length, which has long been considered to be insignificant, will also be elucidated in the near future.

• #58 Clinical Significance of Hiatal Hernia

  https://www.gutnliver.org/journal/view.html?pn=vol&uid=284&vmd=Full

  Esophageal manometry measures intraluminal pressures and coordinated contractile movements of the esophageal musculature. Therefore, it is most commonly applied for assessing peristaltic function of the esophagus and measuring the LES pressure and relaxation, thus aiding in the evaluation of esophageal motility disorders. Although esophageal manometry is generally not indicated and plays a minimal role in diagnosing GERD, it can be used for establishing the presence of a hiatal hernia. […] High resolution manometry seems to hold the key to future studies on hiatal hernia and it is beckoning us to cast the probe deep into the esophagus. With the help of this magnificent apparatus that enables simultaneous luminal pressure monitoring and pressure topography plotting of the entire esophagus from the pharynx to the stomach in real-time, the clinical significance of hiatal hernias measuring less than 2 cm in length, which has long been considered to be insignificant, will also be elucidated in the near future.

• #59 Hiatal Hernia Causes and Diagnoses | Northwestern Medicine

  https://www.nm.org/conditions-and-care-areas/gastroenterology/hiatal-hernia/causes-and-diagnoses

  Diagnosing a hiatal hernia […] A hiatal hernia is often discovered during diagnostic or screening tests for other conditions. Those tests may include: […] Chest X-ray: This common X-ray image may show that you have a hiatal hernia. […] Fiberoptic endoscopy: An endoscope (a thin, lighted tube with a camera attached to it) is passed through your mouth and esophagus. Your physician can look at pictures of your digestive tract and determine if there is a hiatal hernia. […] Capsule endoscopy: A tiny camera, embedded in a small capsule that you swallow, takes pictures of your esophagus. […] Esophagram/barium swallow: A special series of X-rays is taken of your esophagus after you drink small amounts of a liquid containing barium, a contrast material that coats your esophagus and shows up well on X-rays. […] Pharyngeal manometry: A pressure-sensitive tube is passed through your nose and into your stomach to measure pressure inside your esophagus.

• #60 Hiatal hernia – Symptoms, diagnosis and treatment | BMJ Best Practice US

  https://bestpractice.bmj.com/topics/en-us/735

  Hiatal hernia may be asymptomatic or may present with heartburn, dysphagia, odynophagia, hoarseness, asthma, shortness of breath, chest pain, anemia or hematemesis, or a combination of these. […] An upper gastrointestinal fluoroscopy with oral contrast is the key investigation technique and aids the surgeon in characterizing any anatomic variation necessary for preoperative evaluation. Computed tomography scanning with 3-dimensional reconstruction can be helpful if the diagnosis is unclear, or when planning surgery. […] The necessity for, and type of treatment, depends on the patient’s symptoms and the anatomic configuration of the hernia. […] Uncomplicated sliding hiatal hernias are treated symptomatically with medical therapy, although some patients may select surgical therapy. Complicated hiatal hernias (those with bleeding, volvulus, or obstruction) have a stronger indication for surgical repair.

• #61 Paraesophageal (Hiatal) Hernia Diagnosis & Treatment | AHN

  https://www.ahn.org/services/esophageal/conditions/paraesophageal-hernia

  Sedated or unsedated endoscopy with biopsy collection is routinely performed in order to visualize your esophagus and stomach to look for the presence of hernia and screen for Barretts esophagus. […] pH acid monitoring is a disposable capsule placed into your esophagus using an endoscope. It wirelessly transmits information about esophageal acid levels to a receiver worn around your waist for 48 hours. […] High resolution manometry measures the strength, pressure and coordination of your esophagus’ muscles. A specially trained nurse guides a small catheter through your nose and into the esophagus and instructs you to swallow small amounts of liquid at specific intervals. […] A 24-hour impedance catheter is used to measure the reflux of fluid and gauge its proximity to your voice box. This test is typically used for patients who are experiencing cough, respiratory or non-classical GERD symptoms. A small catheter is inserted through your nose and records data in receiver worn around your waist during while you conduct your regular daily activities.

• #62 Optimal workup for a hiatal hernia – Laracca – Annals of Laparoscopic and Endoscopic Surgery

  https://ales.amegroups.org/article/view/5911/html

  In our institution whenever possible we study all the patients scheduled for a hiatal hernia repair with a high resolution manometry (HRM); this exam provides important details about the motility of the esophagus and the EGJ. […] HRM can help to tune the operative strategy since findings of severe dysmotility or pseudoachalasia may indicate a simple hiatal repair without fundoplication. […] The work-up is similar to the non-recurrent patients. […] Patients symptoms, clinical presentations and hiatal hernia type drive the selection of the most appropriate workup for hiatal hernia. For elective HH repair we advocate the use of UGI series, EGD and HRM as first line pre-operative tests. More specific functional and morphological studies such as pH testing, PTF, and CT scan should be used case by case depending on the hernia size, patients symptoms and setting.

• #63 Clinical Significance of Hiatal Hernia

  https://www.gutnliver.org/journal/view.html?pn=vol&uid=284&vmd=Full

  The diagnosis of hiatal hernia can be made through radiographic, endoscopic, and manometric assessment. Whereas large hiatal hernias can be detected and diagnosed without difficulty using either of these methods, diagnosing small hiatal hernias (2 cm) can be challenging with each modality having its limitations. […] The limitation of this method is that it is not always possible to detect all the landmarks of the phrenic ampulla. Defining hiatal hernia especially becomes problematic when the „B” ring, marker necessary for defining the presence of hiatal hernia that is only detectable in about 15% of subjects, cannot be identified. In the absence of the „B” ring, the result of barium contrast studies to diagnose hiatal hernia can become quite inconsistent. […] The use of endoscopy has become widespread over the past few decades and is now considered the standard modality for diagnosing and treating diseases of the upper gastrointestinal tract. Although barium contrast study has been the most commonly applied method for diagnosing hiatal hernia worldwide, hiatal hernia is increasingly diagnosed with endoscopy.

• #64 Clinical Significance of Hiatal Hernia

  https://www.gutnliver.org/journal/view.html?pn=vol&uid=284&vmd=Full

  The diagnosis of hiatal hernia can be made through radiographic, endoscopic, and manometric assessment. Whereas large hiatal hernias can be detected and diagnosed without difficulty using either of these methods, diagnosing small hiatal hernias (2 cm) can be challenging with each modality having its limitations. […] The limitation of this method is that it is not always possible to detect all the landmarks of the phrenic ampulla. Defining hiatal hernia especially becomes problematic when the „B” ring, marker necessary for defining the presence of hiatal hernia that is only detectable in about 15% of subjects, cannot be identified. In the absence of the „B” ring, the result of barium contrast studies to diagnose hiatal hernia can become quite inconsistent. […] The use of endoscopy has become widespread over the past few decades and is now considered the standard modality for diagnosing and treating diseases of the upper gastrointestinal tract. Although barium contrast study has been the most commonly applied method for diagnosing hiatal hernia worldwide, hiatal hernia is increasingly diagnosed with endoscopy.

• #65 Select Hiatal Hernia Finger Test. Hiatal Hernia Finger Test.

  https://synergywellnessny.com/hiatal-hernia-finger-test/

  Its estimated that 50% of people over 50 yrs. Old will be diagnosed with a hiatal hernia in their life, with 95% of those cases being a sliding type 1 hiatal hernia. […] A simple at home Hiatal Hernia Finger Test can help you determine if you may have a hernia. […] Diagnosing a small hiatal hernia of 2cm or less can be very difficult through traditional testing methods. Many small Hiatal hernias are not seen well on endoscopy or barium swallow. […] The Hiatal Hernia Finger Test can quickly help you diagnose a hiatal hernia. Place your fingers straight into your stomach just below the left rib cage, about one inch from the center of your ribs or xiphoid process. […] If at least two of these tests are positive, you most likely have a hiatal hernia. You can then confirm a sliding type 1 hiatal hernia by getting an endoscopy. Unfortunately, there are no guarantees that traditional testing will see and diagnose a small hiatal hernia. Anything below 4 cm is considered a small hiatal hernia.

• #66 Hiatal Hernia Workup: Approach Considerations, Imaging Studies, Procedures

  https://emedicine.medscape.com/article/178393-workup

  The diagnosis of a hiatal hernia actually is incidental, and endoscopy is used to diagnose complications such as erosive esophagitis, ulcers in the hiatal hernia, Barrett esophagus, or tumor. […] A hiatal hernia is confirmed when the endoscope is about to enter the stomach or on retrograde view once inside the stomach. […] Traditionally, esophageal manometry has had a low sensitivity for diagnosing hiatal hernia, as compared to endoscopy, and was therefore not appropriate in helping to establish a diagnosis. […] More recent studies with esophageal high-resolution manometry (HRM) appear to be more accurate for detecting hiatal hernias.

• #67 Hiatus Hernia – Gastrointestinal Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/gastrointestinal-disorders/esophageal-and-swallowing-disorders/hiatus-hernia

  Hiatus hernia is a protrusion of the stomach through the diaphragmatic hiatus. […] Diagnosis is by barium swallow. […] A large hiatus hernia is often discovered incidentally on chest radiograph. Smaller hernias are diagnosed with a barium swallow. […] Hernias can also be seen with upper endoscopy.

• #68 Select Hiatal Hernia Finger Test. Hiatal Hernia Finger Test.

  https://synergywellnessny.com/hiatal-hernia-finger-test/

  Its estimated that 50% of people over 50 yrs. Old will be diagnosed with a hiatal hernia in their life, with 95% of those cases being a sliding type 1 hiatal hernia. […] A simple at home Hiatal Hernia Finger Test can help you determine if you may have a hernia. […] Diagnosing a small hiatal hernia of 2cm or less can be very difficult through traditional testing methods. Many small Hiatal hernias are not seen well on endoscopy or barium swallow. […] The Hiatal Hernia Finger Test can quickly help you diagnose a hiatal hernia. Place your fingers straight into your stomach just below the left rib cage, about one inch from the center of your ribs or xiphoid process. […] If at least two of these tests are positive, you most likely have a hiatal hernia. You can then confirm a sliding type 1 hiatal hernia by getting an endoscopy. Unfortunately, there are no guarantees that traditional testing will see and diagnose a small hiatal hernia. Anything below 4 cm is considered a small hiatal hernia.

• #69 Hiatus hernia | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/hiatus-hernia?lang=us

  Hiatus hernias (alternative plural: herniae) occur when there is herniation of abdominal contents through the esophageal hiatus of the diaphragm into the thoracic cavity. […] Many patients with hiatus hernia are asymptomatic, and it is an incidental finding. However, symptoms may include epigastric or chest pain, postprandial fullness, nausea and vomiting. […] Sometimes hiatus hernias are considered synonymous with gastro-esophageal reflux disease (GERD), but there is a poor correlation between the two conditions. […] In some institutions measurement of a hiatal surface area (HSA) has been proposed. […] Symptomatic hiatus hernias, especially types 2-4, should be managed surgically. […] The mere presence of a sliding hiatus hernia is of limited clinical significance in most cases. The function of the lower esophageal sphincter and the presence of pathologic gastro-esophageal reflux are the crucial factors in producing symptoms and causing complications.

• #70 Hiatus hernia | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/hiatus-hernia?lang=us

  Hiatus hernias (alternative plural: herniae) occur when there is herniation of abdominal contents through the esophageal hiatus of the diaphragm into the thoracic cavity. […] Many patients with hiatus hernia are asymptomatic, and it is an incidental finding. However, symptoms may include epigastric or chest pain, postprandial fullness, nausea and vomiting. […] Sometimes hiatus hernias are considered synonymous with gastro-esophageal reflux disease (GERD), but there is a poor correlation between the two conditions. […] In some institutions measurement of a hiatal surface area (HSA) has been proposed. […] Symptomatic hiatus hernias, especially types 2-4, should be managed surgically. […] The mere presence of a sliding hiatus hernia is of limited clinical significance in most cases. The function of the lower esophageal sphincter and the presence of pathologic gastro-esophageal reflux are the crucial factors in producing symptoms and causing complications.

• #71 Paraesophageal Hernia (Hiatal Hernia) | Minimally Invasive and Gastrointestinal Surgery | Medical College of Wisconsin

  https://www.mcw.edu/departments/surgery/divisions/minimally-invasive-and-gastrointestinal-surgery/patient-care/gerd-and-gastrointestinal-surgery-program/paraesophageal-hernia-hiatal-hernia

  Hiatal hernias are known to contribute to GERD. When diet, lifestyle modifications (lose weight, dont eat late at night, sleep upright), and acid reduction medications fail to adequately control symptoms, hiatal hernia repair may be indicated. […] In general, all paraesophageal hernias causing symptoms should be repaired. […] Many patients (but not all) with paraesophageal hernias may also suffer from gastroesophageal reflux disease symptoms. GERD by itself is not a reason to repair a paraesophageal hernia. GERD is first treated with medications, and surgery is reserved for those who fail medical management. […] Almost all paraesophageal hernias can successfully and safely be repaired laparoscopically (with about 5 very small incisions) and through the abdomen (rather than the chest cavity).

• #72 | General Surgeon & Foregut Surgeon located in Lone Tree, CO | Institute of Esophageal and Reflux Surgery

  https://www.iersurgery.com/content/large-hiatal-hernia-paraesophageal-hernia

  A hiatal hernia occurs when the upper part of the stomach goes up through the opening in the diaphragm (the muscle that separates the chest and the abdomen) that is normally occupied by the esophagus. […] A hiatal hernia is a diagnosis of an anatomic change that can only be made by x-ray studies or upper endoscopy. […] Most hiatal hernias are diagnosed when we are working up symptoms of reflux. […] Some hiatal hernias can become quite large; these are called paraesophageal hernias. This type of hiatal hernia can become serious and requires surgery to repair it, regardless of if you have symptoms. […] The only way to fix a hiatal hernia is surgery. […] If evaluation indicates that these symptoms are likely due to the hiatal hernia, then surgery to repair the hiatal hernia is needed.

• #73 Hiatal hernia – Wikipedia

  https://en.wikipedia.org/wiki/Hiatal_hernia

  The diagnosis of a hiatal hernia is typically made through an upper GI series, endoscopy, high resolution manometry, esophageal pH monitoring, and computed tomography (CT). […] Endoscopy can analyse the esophageal internal surface for erosions, ulcers, and tumours. […] The diagnosis may be confirmed with endoscopy or medical imaging. […] CT scan is useful in diagnosing complications of hiatal hernia such as gastric volvulus, perforation, pneumoperitoneum, and pneumomediastinum.

• #74 Optimal workup for a hiatal hernia – Laracca – Annals of Laparoscopic and Endoscopic Surgery

  https://ales.amegroups.org/article/view/5911/html

  Elective patients suspected for Hiatal Hernia are primarily examined for history of previous surgery, especially upper GI surgery, and comorbidities. Then a thorough analysis of signs and symptoms is mandatory. […] All patients with suspected or confirmed symptomatic hiatal hernia should undergo an esophagogastroduodenoscopy (EGD); however, given the diffusion of endoscopy, hiatal hernias are frequently diagnosed when endoscopy has been already performed for other symptoms and/or reasons. Endoscopy helps defining the anatomy, the size and type of the hernia, any associated esophageal and gastric mucosal disease such as esophagitis, Barretts esophagus and cancer. […] A hiatal hernia is diagnosed by EGD evaluating the distance between the EGJ and the diaphragmatic incisura, which is the impression of the diaphragmatic hiatus on the gastric wall. The endoscopic hiatal hernia diagnosis is defined as a distance greater than 2 cm.

• #75 The management of hiatal hernia: an update on diagnosis and treatment

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6853045/

  Barium swallow radiography gives valuable information about the size of the herniated stomach and the location of the gastroesophageal junction. Most studies agree that barium swallow still remains essential in the diagnosis of hiatal hernia. […] Esophageal manometry provides valuable information regarding the motility of the esophagus. It is considered that a separation between the crural diaphragm and lower esophageal sphincter of 2 cm or more is diagnostic for hiatal hernia. […] The current guideline for the surgical treatment of hiatal hernia was elaborated by the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) in the year 2013. Through our literature research we have found that indications for surgery remain the same: symptomatic patients with paraesophageal hernia, especially those with obstructive symptoms and gastric volvulus, which require urgent surgery. […] The SAGES Guidelines strongly recommend not repairing type I hiatal hernia in the absence of reflux disease and symptoms; this recommendation remains valid to this day, as sustained by several authors.

• #76 Approaches to the Diagnosis and Grading of Hiatal Hernia

  https://pmc.ncbi.nlm.nih.gov/articles/PMC2548324/

  The radiographic demonstration of a sliding hiatus hernia is usually done in the setting of a barium swallow examination. […] Recognition of this confounding effect led to the 2 cm rule wherein there must be more than 2 cm separation between the B ring and the diaphragmatic hiatus before being considered a sliding hiatus hernia. […] Sliding hiatus hernia is diagnosed when the apparent separation between the squamocolumnar junction and the diaphragmatic impression is greater than 2 cm as measured using the hash marks on the endoscope. […] High resolution manometry objectifies the assessment of sliding hiatus hernia. For the first time, it offers a means to complete the continuum from normal to overt sliding hernia by detecting intermediate grades of EGJ disruption.

• #77 Hiatal Hernia | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/22859

  Hiatal hernias can cause symptoms such as heartburn, regurgitation, and difficulty swallowing. […] The preoperative workup in a patient being considered for operative treatment will help confirm the diagnosis, exclude other pathologic entities, and direct the operative intervention. Endoscopy is an essential step in evaluating GERD and a suspected hiatal hernia in patients being considered for surgery. […] The 24-hour pH test is the gold standard for diagnosing acid reflux. […] The management of hiatal hernias depends on the type of hernia and the severity of the symptoms. […] The indications for surgical therapy have changed since the advent of PPIs. […] The Nissen fundoplication (360 wrap) involves completely wrapping the GEJ using the stomach fundus. […] Advances in minimally invasive surgery have led to the widespread acceptance of laparoscopic hernia repair.

• #78 Optimal workup for a hiatal hernia – Laracca – Annals of Laparoscopic and Endoscopic Surgery

  https://ales.amegroups.org/article/view/5911/html

  In our institution whenever possible we study all the patients scheduled for a hiatal hernia repair with a high resolution manometry (HRM); this exam provides important details about the motility of the esophagus and the EGJ. […] HRM can help to tune the operative strategy since findings of severe dysmotility or pseudoachalasia may indicate a simple hiatal repair without fundoplication. […] The work-up is similar to the non-recurrent patients. […] Patients symptoms, clinical presentations and hiatal hernia type drive the selection of the most appropriate workup for hiatal hernia. For elective HH repair we advocate the use of UGI series, EGD and HRM as first line pre-operative tests. More specific functional and morphological studies such as pH testing, PTF, and CT scan should be used case by case depending on the hernia size, patients symptoms and setting.

• #79 The management of hiatal hernia: an update on diagnosis and treatment

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6853045/

  Barium swallow radiography gives valuable information about the size of the herniated stomach and the location of the gastroesophageal junction. Most studies agree that barium swallow still remains essential in the diagnosis of hiatal hernia. […] Esophageal manometry provides valuable information regarding the motility of the esophagus. It is considered that a separation between the crural diaphragm and lower esophageal sphincter of 2 cm or more is diagnostic for hiatal hernia. […] The current guideline for the surgical treatment of hiatal hernia was elaborated by the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) in the year 2013. Through our literature research we have found that indications for surgery remain the same: symptomatic patients with paraesophageal hernia, especially those with obstructive symptoms and gastric volvulus, which require urgent surgery. […] The SAGES Guidelines strongly recommend not repairing type I hiatal hernia in the absence of reflux disease and symptoms; this recommendation remains valid to this day, as sustained by several authors.

• #80 Hiatal hernia – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/hiatal-hernia/diagnosis-treatment/drc-20373385

  If you’ve been diagnosed with a hiatal hernia and your problems persist after you make lifestyle changes and start medicine, you might be referred to a doctor who specializes in digestive diseases, called a gastroenterologist. […] What tests do I need? […] Surgery may help people who aren’t helped by medicines to relieve heartburn and acid reflux. Surgery also may help people who have complications such as serious inflammation or narrowing of the esophagus. […] Surgery to repair a hiatal hernia may involve pulling the stomach down into the abdomen and making the opening in the diaphragm smaller. Surgery also may involve reshaping the muscles of the lower esophagus. This helps keep the contents of the stomach from coming back up. […] Surgery may be performed using a single incision in the chest wall, called a thoracotomy. Surgery also may be performed using a technique called laparoscopy. In laparoscopic surgery, a surgeon inserts a tiny camera and special tools through several small incisions in the abdomen. The operation is then performed by a surgeon who views images from inside the body that are displayed on a video monitor.

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