Clinical features

Many are patients are asymptomatic.

There are no specific symptoms for hiatus hernia. Clinical features, where present, may include:

• gastroesophageal reflux disease (GERD):
  • due to incompetence of the cardiac sphincter
  • 'heartburn' after meals that is made worse by stooping or lying down
  • studies in Western countries have reported that over half of patients (50% to 94%) with reflux esophagitis had concomitant hiatal hernias (prevalence of hiatal hernia in the control subjects were 13% to 59%)
• regurgitation of food at night, leading to aspiration pneumonia
• dysphagia
  • in part caused by reflux but also due to inefficient peristalsis resulting from movement of the hernia upwards as the oesophagus contracts
• duodenal or gastric ulcer
• Saint's triad - a sliding hiatus hernia is associated with gallstones and diverticular disease
• nausea and vomiting are common in children but not in adults
• waterbrash
• children may present as failure to thrive, and with anaemia (1)

Reference:

• (1) Roman S, Kahrilas PJ. The diagnosis and management of hiatus hernia. BMJ. 2014;349:g6154