Hiatal hernia - Symptoms, Causes, Images, and Treatment Options

Diseases

Highlights & Basics

Key Highlights

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.
Common risk factors are obesity and increased age. Other known risk factors include intra-abdominal pressure from various conditions, and a previous hiatal operation.
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.

Quick Reference

History & Exam
- Key Factors
- Other Factors
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Diagnostics Tests
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Treatment Options
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Definition

Epidemiology

Etiology

Pathophysiology

Images

Types of hiatal hernia
Type IV paraesophageal hiatus hernia: (A) Frontal chest x-ray revealing a large intrathoracic gastric bubble (arrows); (B) Air-fluid level confirming intrathoracic gastric contents on the right lateral decubitus chest x-ray (arrow)

Citations

Key Articles

Society of American Gastrointestinal and Endoscopic Surgeons. Guidelines for the management of hiatal hernia. Apr 2013 [internet publication].[Full Text]
Roman S, Kahrilas PJ. The diagnosis and management of hiatus hernia. BMJ. 2014 Oct 23;349:g6154.[Abstract]
Sfara A, Dumitrascu DL. The management of hiatal hernia: an update on diagnosis and treatment. Med Pharm Rep. 2019 Oct;92(4):321-25.[Abstract][Full Text]
Antoniou SA, Müller-Stich BP, Antoniou GA, et al. Laparoscopic augmentation of the diaphragmatic hiatus with biologic mesh versus suture repair: a systematic review and meta-analysis. Langenbecks Arch Surg. 2015 Jul;400(5):577-83.[Abstract]

Referenced Articles

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