Hiatus hernia differential diagnosis

Hiatus Hernia Microchapters
Home
Patient Information
Overview
Historical Perspective
Classification
Pathophysiology
Causes
Differentiating Hiatus Hernia from other Diseases
Epidemiology and Demographics
Risk Factors
Screening
Natural History, Complications and Prognosis
Diagnosis
Diagnostic Study of Choice
History and Symptoms
Physical Examination
Electrocardiogram
Chest X Ray
Echocardiography or Ultrasound
MRI
CT
Other Imaging Findings
Other Diagnostic Studies
Treatment
Medical Therapy
Surgery
Primary Prevention
Secondary Prevention
Cost-Effectiveness of Therapy
Future or Investigational Therapies
Case Studies
Case #1
Hiatus hernia differential diagnosis On the Web
Most recent articles
Most cited articles
Review articles
CME Programs
Powerpoint slides
Images
American Roentgen Ray Society Images of Hiatus hernia differential diagnosis All Images X-rays Echo & Ultrasound CT Images MRI
Ongoing Trials at Clinical Trials.gov
US National Guidelines Clearinghouse
NICE Guidance
FDA on Hiatus hernia differential diagnosis
CDC on Hiatus hernia differential diagnosis
Hiatus hernia differential diagnosis in the news
Blogs on Hiatus hernia differential diagnosis
Directions to Hospitals Treating Hiatus hernia
Risk calculators and risk factors for Hiatus hernia differential diagnosis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:

Overview

[Disease name] must be differentiated from other diseases that cause [clinical feature 1], [clinical feature 2], and [clinical feature 3], such as [differential dx1], [differential dx2], and [differential dx3].

OR

[Disease name] must be differentiated from [[differential dx1], [differential dx2], and [differential dx3].

Differentiating hiatus hernia from other diseases

• Hiatus hernia presents as gasytroesophagela reflux disease(GERD) with dysphagia and must be differentiated from other causes of dysphagia:{| class="wikitable"

! rowspan="3" align="center" style="background:#4479BA; color: #FFFFFF;" |Disease ! colspan="8" align="center" style="background:#4479BA; color: #FFFFFF;" |Signs and Symptoms ! rowspan="3" align="center" style="background:#4479BA; color: #FFFFFF;" |Barium esophagogram ! rowspan="3" align="center" style="background:#4479BA; color: #FFFFFF;" |Endoscopy ! rowspan="3" align="center" style="background:#4479BA; color: #FFFFFF;" |Other imaging and laboratory findings ! rowspan="3" align="center" style="background:#4479BA; color: #FFFFFF;" |Gold Standard |- | rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" |Onset | colspan="3" align="center" style="background:#4479BA; color: #FFFFFF;" |Dysphagia | rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" |Weight loss | rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" |Heartburn | rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" |Other findings | rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" |Mental status |- | align="center" style="background:#4479BA; color: #FFFFFF;" |Solids | align="center" style="background:#4479BA; color: #FFFFFF;" |Liquids | align="center" style="background:#4479BA; color: #FFFFFF;" |Type |- | style="padding: 5px 5px; background: #DCDCDC;" align="center" |Plummer-Vinson syndrome |Gradual | + | - |Non progressive | +/- | - |

• Glossitis

• Koilonychia

|Normal |

• Thin projections on the anterior esophageal wall
• Multiple upperesophageal constrictions

|

• Direct visualization of esophageal webs
• Superior to esophagogram

|

• Videofluoroscopy shows mucosal and submucosal foldings

| Triad of

• Iron deficiency anemia
• Esophageal webs
• Glossitis

|- | style="padding: 5px 5px; background: #DCDCDC;" align="center" |Esophageal stricture |Gradual or sudden | + | - |Progressive | +/- | +/- |

• Odynophagia
• Cough

• Chest pain

|Normal |

• Sacculations
• Fixed transverse folds
• Esophageal intramural pseudodiverticula   

|

• Mucosal edema
• Circumferential thickening in GERD
• Pale mucosa with white exudate in lymphocytic esophagitis

• Swelling and hemorrhagic congestion in causticingestion

|

• Manometry may show dysmotility
• CT scan for staging malignant strictures

|

• Barium esophagogram

|- | style="padding: 5px 5px; background: #DCDCDC;" align="center" |Diffuse esophageal spasm |Sudden |+ |+ |Non progressive |+ |+ |

• Chest pain

|Normal |

• Nonperistaltic and nonpropulsive contractions
• Corkscrew or rosary bead esophagus

|

• Inconclusive

|

• Manometry shows high-amplitude esophageal contractions
• CT scan may show hypertrophy of esophageal muscles

|

• Manometry

|- | style="padding: 5px 5px; background: #DCDCDC;" align="center" |Achalasia |Gradual | + |+ |Non progressive | +/- | - |

• Regurgitation of undigested food
• Chest pain

|Normal |

• "Bird's beak" or "rat tail" appearance
• Dilated esophageal body
• Air fluid level (absent peristalsis)
• Absence of an intragastric air bubble

|

• Dilated esophagus
• Residual food fragments
• Normal mucosa

|

• Residual pressure of LES > 10 mmHg
• Incomplete relaxation of the LES
• Increased resting tone of LES
• Aperistalsis

|

• History of dysphagia with positive endoscopy and manometry

|- | style="padding: 5px 5px; background: #DCDCDC;" align="center" |Systemic sclerosis |Gradual | + |+ |Progressive | +/- | + |

• Muscle and joint pain

• Raynaud's phenomenon

• Skin changes

|Normal |

• Dysmotility

• Patulous esophagus

|

• Mucosal damage

• Peptic stricture (advanced cases)

|Positive serology for

• Antinuclear antibodies

• Rheumatoid factor

• Creatine kinase

• ESR

|

• Skin biopsy

|- | style="padding: 5px 5px; background: #DCDCDC;" align="center" |Zenker's diverticulum |Gradual | + |- | | +/- | - |

• Food regurgitation

• Halitosis

• Cough

• Hoarseness

|Normal |

• Thin projections on esophageal wall over Killian's triangle

|

• Outpouching of posterior pharyngeal wall

• Exclude the presence of SCC 

|

• CT & MRI shows out-pouching over the posterior esophagus in the Killian's triangle

|

• Barium esophagography

|- | style="padding: 5px 5px; background: #DCDCDC;" align="center" |Esophageal carcinoma |Gradual |+ |+ |Progressive | + |+/- |

• Lymphadenopathy

• Cachexia

|Normal |

• Irregular stricture
• Pre-stricture dilatation

|

• Esophageal obstruction
• Staging of disease

|

• CT and PET scan is an optional test for staging of the disease

|

• Biopsy

|- | style="padding: 5px 5px; background: #DCDCDC;" align="center" |Stroke (Cerebral hemorrhage) |Sudden |+ |+ |Progressive |+ |+/- |

• Dysarthria

• Limb weakness

• Fatigue

|Impaired |

• Pooling of contrast in the pharynx
• Aspiration of barium contrast into the airway

|

• Reduced opening of upper esophageal sphincter
• Reduced larynx elevation

|

• CT without contrast shows acute hemorrhage as a hyperattenuating clot

|

• CT without contrast

|- | style="padding: 5px 5px; background: #DCDCDC;" align="center" |Motor disorders (Myasthenia gravis) |Gradual | + | + |Progressive |+/- | |

• Ptosis
• Diplopia
• Fatigue

|Normal |

• Stasis in pharynx and pooling in pharyngeal recesses

|

• Velopharyngeal insufficiency
• Delayed swallowing function

|

• CT may show anterior mediastinal mass (thymoma)
• Positive tensilon test

|

• Anti–acetylcholine receptor antibody test

|- | style="padding: 5px 5px; background: #DCDCDC;" align="center" |GERD |Gradual or

sudden onset | + | - |Progressive | +/- | + |

• Cough

• Hoarseness

|Normal |

• Free acid reflux
• Esophagitis with scarring
• Strictures
• Barrett's oesophagus

|

• Erythema, erosions and ulceration
• Barrett's esophagus

|

• Esophageal manometry may show decreased tone of LES

|

• 24 hour esophageal pH monitoring

|- | style="padding: 5px 5px; background: #DCDCDC;" align="center" |Esophageal web |Gradual | + | +/- |Progressive | - | +/- |

• Findings of the underlying cause such as iron deficiency anemia or bullous pemphigoid

|Normal |

• Symmetrical narrowing of the esophagus

|

• Smooth membrane not encircling the whole lumen

|

• Videofluoroscopy shows mucosal and submucosal foldings

|

• Barium esophagogram

|}