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Hiatal hernia

Last reviewed: 10 Nov 2024
Last updated: 23 Jul 2024

Summary

Definition

History and exam

Key diagnostic factors

  • bowel sounds in chest
Full details

Other diagnostic factors

  • heartburn
  • regurgitation
  • obesity
  • chest pain
  • dysphagia
  • odynophagia
  • hematemesis
  • shortness of breath
  • cough
  • oropharyngitis
  • wheezing
  • nonbilious vomiting
  • fever and chills
  • confusion
Full details

Risk factors

  • obesity
  • increased age
  • previous gastroesophageal procedure
  • elevated intra-abdominal pressure
  • male sex
  • incisional, umbilical, or inguinal hernia
Full details

Diagnostic tests

1st tests to order

  • chest x-ray
  • upper gastrointestinal fluoroscopy with oral contrast
Full details

Tests to consider

  • esophago-gastro-duodenoscopy
  • CT scan or MRI scan
  • high-resolution esophageal manometry and pH monitoring
Full details

Treatment algorithm

INITIAL

upper gastrointestinal hemorrhage and/or obstruction and/or volvulus

irreversible organ ischemia and/or necrosis

ACUTE

symptomatic gastroesophageal reflux disease (GERD)

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.

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 and Dr Mark A. Carlson would like to gratefully acknowledge Dr Amy J. Hargrove and Dr Minh B. Luu, previous contributors to this topic. AJH and MBL declare they have 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.

  • Hiatal hernia images
  • Differentials

    • Angina pectoris
    • Gastroesophageal reflux disease (GERD)
    • Pneumonia
    More Differentials
  • Guidelines

    • Informed consent for GI endoscopic procedures
    • Adverse events associated with EGD and EGD-related techniques
    More Guidelines
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