History: Most hiatal hernias cause no symptoms; they are discovered incidentally from the results of chest x-ray or computed tomography (CT) scans taken for unrelated reasons. Individuals may report heartburn or chest pain that is more pronounced when they are lying flat, indicative more of coexisting GERD and hiatal hernia than of hiatal hernia alone. Initial symptoms of hiatal hernia, however, may be similar to reflux symptoms. Heartburn may wake the individual at night, or it may be more noticeable in the morning. Heartburn often is reported 30 to 60 minutes after eating or drinking. Individuals may report the sensation that food is sticking in the chest or upper abdomen, and they may complain of food or stomach acid regurgitating into the mouth. Physical exam: A physical exam is not helpful for this diagnosis. Risk factors such as pregnancy, obesity, and excess abdominal fluid (ascites) may increase suspicion of hiatal hernia and encourage appropriate tests. Tests: The diagnostic tool of choice for hiatal hernia is an upper gastrointestinal (GI) barium series. In this procedure, the esophagus and stomach are visualized by making a series of x-rays after the individual swallows a radiopaque dye (barium swallow). Movement of the barium is followed into the stomach and intestine. Other methods may further define the condition: A flexible fiberoptic instrument with a microscope at its tip can be inserted into the esophagus (esophagoscopy) for direct visualization and diagnosis. A tissue sample (biopsy) of the esophagus may be taken during esophagoscopy for microscopic analysis. A motility study may determine if the esophagus and stomach are contracting properly. A complete blood count (CBC) may be done to evaluate for anemia. Other tests may include measurement of pressure in the esophagus (esophageal manometry), measurement of stomach acid production (pH telemetry), determination of how well the esophagus is functioning (esophageal clearance studies), and an assessment of heart function (electrocardiogram [ECG]). |
Source: Medical Disability Advisor