Diagnosis Of Hiatal Hernias Can Be Tricky
Hiatus hernias are mostly asymptomatic. They are usually recognized incidentally while taking chest x-ray for some other condition. Type I hernia is often associated with gastroesophageal reflux but does not cause any direct symptoms. Paraesophageal hernia causes pain after taking food, bloating, anemia and may or may not be associated with gastroesophageal reflux. Paraesophgeal are often the cause of unexplained anemia in elderly persons. Large paraesophageal hernias cause breathlessness. Obstruction, volvulus (twisting of its contents) and strangulation (compression with compromise in the blood supply) are its complications.
Most hiatus hernias are diagnosed while taking chest x-rays as air fluid level. Upper gastrointestinal contrast study is the gold standard test for diagnosing hiatus hernias. Upper gastrointestinal endoscopy will verify the presence of esophagitis, gastritis, Cameron’s ulcer or lesions that can mimic the symptoms of paraesophgeal hernia. Esophagitis is the inflammation of the esophagus. Gastritis is the inflammation of the stomach. Cameron’s ulcer is the linear ulcer at the junction of the stomach and esophagus.
Esophageal manometry and 24 hours pH monitoring are not mandatory for diagnosis or in its work up. It has been demonstrated that most of these patients have a defective lower esophageal sphincter and about half have abnormal gastroesophageal reflux.
Sliding hiatus hernia is usually asymptomatic and do not require any treatment. Paraesophgeal hernia may produce symptoms and a few complications also. Surgery for paraesophageal hernia is complex and requires more technical expertise. The decision to proceed with surgical repair should be carefully considered. It is done in patients who are younger, fit patients under 60 years of age and in those with symptoms who do not have a prohibitive operative risk.