Investigations
A sliding hiatus hernia may be diagnosed by radiographic, endoscopic, and manometric assessment. These methods can be used to identify large hiatal hernias but differentiating a small hernia (<2 cm) from normal can be challenging with each modality having its limitations.
- radiography
- usually done in the setting of a barium swallow examination.
- carried out during presurgical evaluation
- contraindicated in pregnancy
- CT
- not a standard procedure in the investigation of hiatus hernia
- useful in - assessing gastric volvulus in patients with paraesophageal hernia and to detect other herniated organs
- endoscopy
- diagnosed when the distance between diaphragmatic indentation and the squamocolumnar junction is greater than 2cm
- in the absence of symptoms typical of gastro esophageal reflux disease (GERD), there is no clinical indication to systematically search for hiatus hernia.
- oesophageal manometry
- high resolution manometry and reflux monitoring is done when surgery is being considered.
Reference:
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