EGD (endoscopy): Good diagnostic modality for Hiatal hernias and to rule out any other pathology that can be causing the symptoms.CT Scan: Can be very useful in patients with larger hernias or complex hernias.Contrast X-ray or Upper GI series: My test of choice not only for diagnosis but also to evaluate the size of the hernia, esophageal motility and/or reflux.Plain X-rays: Usually negative unless the patient has a large paraesophageal hernia.
Other patients can present with:īecause many patients are asymptomatic or many have nonspecific symptoms the diagnosis of Hiatal hernias usually requires other test modalities besides the good old history and physical. Most small hernias are asymptomatic, but this is also true for some larger paraesophageal hernias. Symptoms are usually associated with the size of the hernia. Similarly, chronic vomiting, constipation or heavy lifting can be associated with Hiatal hernias. Smoking or chronic respiratory conditions: Coughing increases the intra-abdominal pressure significantly, so any condition that promotes chronic coughing can increase your chance of having a hiatal hernia.
Age: The incidence increases with advancing age.Sex: Women are four times more likely to develop a hiatal hernia versus male patients.The diaphragm is a muscle that divides the chest from the abdomen and any condition or circumstances that weakens this area can predispose the patient to develop a hiatal hernia or paraesophageal hernia. In this hernia not only the stomach is herniating but also other organs like small bowel, colon, spleen or liver.Īs I briefly mentioned above, Hiatal hernias happen when the hiatus enlarges and allows the stomach or other organs to herniate into the chest. Only 4-5 % of all Hiatal hernias are Type IV. Type IV: This is the mother of Hiatal hernias but also the least common.Most patients with this defect have over 1/3 of the stomach in the chest. The GE junction and a portion of the stomach are both in the chest. Type III: Is a combination of Type I and II.Here the gastroesophageal junction is in the abdomen but a portion of the stomach sneaks around the esophagus and up in the chest. Type II or Paraesophageal hiatal hernia: This is where it gets more complicated.A Type I hiatal hernia means that the GE junction slides up and down through the hiatus into the chest and back into the abdomen. Type I or Sliding hiatal hernia: This one is the most common accounting for 95% of the cases.What you really want to know is if your hiatal hernia needs to be fix or not. The classification is more important information for doctors than for patients. I’m going to try to make this easy for you. Hiatal hernias are classified depending on the location of the gastroesophageal (GE) junction. This usually happens because of the pressure difference between the chest and the abdomen. This type of hernia happens when the diaphragmatic hiatus (natural orifice were the esophagus goes through and meets the stomach in the abdomen) enlarges and allows the stomach to herniate into the chest. Most patients don’t know they have a hiatal hernia, most are diagnosed incidentally during X-rays or endoscopies for other reasons. Most of them are asymptomatic however, an estimated 5% of patients with a hiatal hernia have symptoms that we will discuss later on this post. An estimated 10% of the adult population in the United States of America have a hiatal hernia.
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