Hiatus hernia other imaging findings
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Vamsikrishna Gunnam M.B.B.S [2]
Overview
A hiatal hernia occurs when a part of the stomach protrudes into the thoracic cavity through the esophageal hiatus of the diaphragm. Approximately 99% of hiatal hernia are sliding, and the rest 1% are paraesophageal hernia. Barium swallow may be helpful in the diagnosis of a hiatus hernia. Findings on a barium swallow suggestive hiatus hernia include anatomy and size of a hernia, the orientation of the stomach location of the gastroesophageal junction.
Barium Swallow
.Barium swallow may be helpful in the diagnosis of a hiatal hernia. Findings on an barium swallow suggestive of hiatus hernia include:[1][2][3]
- Anatomy of a hernia
- Size of a hernia
- Orientation of the stomach
- Location of the gastroesophageal junction
- If a sliding hernia is suspected a greater than a 2 cm division between the mucosal B ring at the site of the squamocolumnar junction and the diaphragmatic hiatus is noticed.
- If B ring not identified on barium swallow, evident of at least 3 rugal folds is diagnostic of a sliding hiatus hernia.
- On barium swallow, herniating of gastric fundus along the distal esophagus is diagnostic of a paraesophageal hernia.
Upper Endoscopy
Upper endoscopy may be helpful in the diagnosis of hiatus hernia. Findings on an upper endoscopy suggestive of hiatus hernia include:[4]
- Larger than 2-cm separation between the squamocolumnar junction and the diaphragm.
- In paraesophageal hernia, upper endoscopy demonostartes herniation of a portion of the stomach upward through the diaphragm adjacent to the endoscope.
High Resolution Manometry
High resolution manometry with esophageal pressure topography (EPT) may be helpful in the diagnosis of hiatus hernia. Findings on an high resolution manometry suggestive of hiatus hernia include:[5]
- Separation of the crural diaphragm from the lower esophageal sphincter (LES) by a pressure trough.
- Enables the identification of intermittent herniation.
- Identify a sliding hiatus hernia as it permits real-time localization of the esophagogastric junction.
References
- ↑ Kahrilas PJ, Kim HC, Pandolfino JE (2008). "Approaches to the diagnosis and grading of hiatal hernia". Best Pract Res Clin Gastroenterol. 22 (4): 601–16. doi:10.1016/j.bpg.2007.12.007. PMC 2548324. PMID 18656819.
- ↑ Hyun JJ, Bak YT (2011). "Clinical significance of hiatal hernia". Gut Liver. 5 (3): 267–77. doi:10.5009/gnl.2011.5.3.267. PMC 3166665. PMID 21927653.
- ↑ Weitzendorfer M, Köhler G, Antoniou SA, Pallwein-Prettner L, Manzenreiter L, Schredl P, Emmanuel K, Koch OO (2017). "Preoperative diagnosis of hiatal hernia: barium swallow X-ray, high-resolution manometry, or endoscopy?". Eur Surg. 49 (5): 210–217. doi:10.1007/s10353-017-0492-y. PMC 5653726. PMID 29104588.
- ↑ Kahrilas PJ, Kim HC, Pandolfino JE (2008). "Approaches to the diagnosis and grading of hiatal hernia". Best Pract Res Clin Gastroenterol. 22 (4): 601–16. doi:10.1016/j.bpg.2007.12.007. PMC 2548324. PMID 18656819.
- ↑ Kahrilas PJ, Kim HC, Pandolfino JE (2008). "Approaches to the diagnosis and grading of hiatal hernia". Best Pract Res Clin Gastroenterol. 22 (4): 601–16. doi:10.1016/j.bpg.2007.12.007. PMC 2548324. PMID 18656819.