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Investigations

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

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A sliding hiatus hernia may be diagnosed by radiographic, endoscopic, and manometric assessment. These methods can be used to identify large hiatal hernias but differentiating a small hernia (<2 cm) from normal can be challenging with each modality having its limitations.

  • radiography
    • usually done in the setting of a barium swallow examination.
    • carried out during presurgical evaluation
    • contraindicated in pregnancy
    • CT
      • not a standard procedure in the investigation of hiatus hernia
      • useful in - assessing gastric volvulus in patients with paraesophageal hernia and to detect other herniated organs
  • endoscopy
    • diagnosed when the distance between diaphragmatic indentation and the squamocolumnar junction is greater than 2cm
    • in the absence of symptoms typical of gastro esophageal reflux disease (GERD), there is no clinical indication to systematically search for hiatus hernia.
  • oesophageal manometry
    • high resolution manometry and reflux monitoring is done when surgery is being considered.

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