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:

• (1) Roman S, Kahrilas PJ. The diagnosis and management of hiatus hernia. BMJ. 2014;349:g6154
• (2) van Herwaarden MA, Samsom M, Smout AJ.The role of hiatus hernia in gastro-oesophageal reflux disease. Eur J Gastroenterol Hepatol. 2004;16(9):831-5