Hiatus hernia

Last reviewed: 8 Nov 2022
Last updated: 13 May 2022

Summary

Definition

History and exam

Key diagnostic factors

  • presence of risk factors
  • bowel sounds in chest
More key diagnostic factors

Other diagnostic factors

  • heartburn
  • regurgitation
  • obesity
  • chest pain
  • dysphagia
  • odynophagia
  • haematemesis
  • shortness of breath
  • cough
  • oropharyngitis
  • wheezing
  • non-bilious vomiting
  • fever and chills
  • confusion
Other diagnostic factors

Risk factors

  • obesity
  • increased age
  • previous gastro-oesophageal procedure
  • elevated intra-abdominal pressure
  • male sex
  • structural abnormalities of the oesophageal hiatus or the phreno-oesophageal ligaments
  • incisional, umbilical, or inguinal hernia
  • disorder of collagen metabolism
More risk factors

Diagnostic investigations

1st investigations to order

  • chest x-ray
  • contrast upper gastrointestinal series (barium oesophagram)
More 1st investigations to order

Investigations to consider

  • oesophago-gastro-duodenoscopy
  • CT scan or MRI scan
  • high-resolution oesophageal manometry and pH monitoring
More investigations to consider

Treatment algorithm

INITIAL

upper gastrointestinal haemorrhage and/or obstruction and/or volvulus

irreversible organ ischaemia and/or necrosis

ACUTE

symptomatic gastro-oesophageal reflux disease (GORD)

ONGOING

type I refractory to medical therapy or patient prefers surgery

types II, III, and IV

Contributors

Authors

Constantine T. Frantzides, MD, PhD, FACS
Constantine T. Frantzides

Director

Chicago Institute of Minimally Invasive Surgery

St. Francis Hospital

Clinical Professor of Surgery

University of Illinois Chicago

Chicago

IL

Disclosures

CTF declares that he has no competing interests.

Amy J. Hargrove, MD, MPH

General Surgery Resident

University of Nebraska Medical Center

Omaha

NE

Disclosures

AJH declares that she has no competing interests.

Mark A. Carlson, MD, FACS

Director

Center for Advanced Surgical Technology

Professor

Department of Surgery

University of Nebraska Medical Center

Omaha

NE

Disclosures

MAC declares that he has no competing interests.

Acknowledgements

Dr Constantine T. Frantzides, Dr Amy Hargrove, and Dr Mark A. Carlson would like to gratefully acknowledge Dr Minh B. Luu, a previous contributor to this topic. MBL declares that he has no competing interests.

Peer reviewers

Frank A. Granderath, MD

Associate Professor

Department of General, Visceral and Transplant Surgery

University Hospital Tuebingen

Germany

Disclosures

FAG declares that he has no competing interests.

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