Table of ContentsView AllTable of ContentsX-RaysBarium SwallowCT ScanUpper GI EndoscopyEsophageal ManometryEsophageal pH MonitoringSelf DiagnosisClassificationDifferential DiagnosisNext in Hiatal Hernia GuideHow a Hiatal Hernia Is Treated
Table of ContentsView All
View All
Table of Contents
X-Rays
Barium Swallow
CT Scan
Upper GI Endoscopy
Esophageal Manometry
Esophageal pH Monitoring
Self Diagnosis
Classification
Differential Diagnosis
Next in Hiatal Hernia Guide
Diagnosing a hiatal hernia involves imaging studies like X-rays, CT scans, and endoscopy. Although severe hiatal hernias might be evident for self-diagnosis, most are much too small to be felt and a healthcare provider will need to run tests.
A hiatal hernia occurs when a portion of the stomach, and sometimes other abdominal structures, is able to bulge upward into the chest through a defect in the diaphragm. Since mosthiatal herniasdo not cause symptoms, they are usually discovered during a routine chest X-ray for an unrelated condition. At other times, a hiatal hernia may be suspected in people with severe acid reflux who fail to respond to antacids or other treatments. For such cases, there are several tests healthcare providers can use to confirm the diagnosis.
In this article, the various methods of testing for hiatal hernias are discussed, along with how hiatal hernias are classified. It will also discuss the differential diagnosis of hiatal hernias.
© Verywell, 2018
Since a hiatal hernia often doesn’t cause serious symptoms, the first clue that you have a hernia may come when your healthcare provider reviews a chest X-ray ordered for an unrelated issue.Your healthcare provider will likely order additional tests to be sure the image that appears isn’t alung abscessor other possible disorder.
Smallerhiatal herniasare often challenging to spot on a regularX-rayand may only appear as a gas-filled structure in the chest cavity. Imaging tests such as an upper GI barium study or computed tomography (CT) scan may also be ordered to provide better definition.
The preferred method of diagnosis of a hiatal hernia is an upper gastrointestinal (GI) barium study. Known as abarium swallowor an esophagram, the test requires you to drink roughly 1.5 cups of chalky fluid containing barium sulfate and, about 30 minutes later, undergo a series of X-rays. The metallic substance coats the esophagus and stomach, helping to isolate them in the imaging results.
Expect to be strapped to a table as you undergo the X-rays. During the study, the table is tilted as you drink additional barium.
While the procedure is considered safe, it can cause constipation and, in rare cases,fecal impaction. If you are unable to have a bowel movement two to three days after the procedure, call your healthcare provider.
A barium study is often enough to make a definitive diagnosis. When it’s unable to do so, acomputed tomography (CT)scan may be ordered. This may be necessary for people with previous abdominal surgery or obesity.
A CT scan can be invaluable in an emergency, such as agastric volvulus(a serious condition in which the stomach twists more than 180 degrees) or strangulation (where compression or twisting of the herniation entirely cuts off the blood supply).
A hiatal hernia can also be diagnosed with a procedure known as anupper GI endoscopy. This is a direct viewing method in which a flexible scope, called an endoscope, is inserted into your throat to get live images of the esophagus, stomach, andduodenum(the first part of the small intestines).
Theprocedurewill require you to stop eating or drinking four to eight hours before testing. Before the procedure, you are given an intravenous sedative to help relax you. A numbing spray for your throat may also be used. The procedure usually takes between 10 and 20 minutes, with an additional hour needed to recover from the sedation.
Endoscopy can sometimes cause bloating, gas, cramping, and sore throat. Call your healthcare provider if you develop a fever, chills, abdominal pain, or bleeding from the throat.
Esophageal manometryis a newer technology that evaluates how the muscles of the esophagus and esophageal sphincter (valve) are functioning, whereas a possible diagnostic test is more commonly done after diagnosis and before a possible surgical repair.Esophageal manometry can help your healthcare provider identify motor dysfunctions, such asdysphagia(difficulty swallowing), and how your hernia may contribute to them.
A manometry result can help your healthcare provider determine the appropriate course of treatment. A sore throat and nose irritation are the most common side effects.
You’ll need a medical test to tell if you have a hiatal hernia. In some instances, a hernia may be large enough for you to feel through your skin, which would result in an enlarged opening around yourdiaphragm.However, hiatal hernias are usually too small to be felt with your own hands.
Classifying a Hiatal Hernia
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Even if a hiatal hernia is confirmed, a differential diagnosis may be needed to exclude other causes, especially if the hernia is small and inconsistent with the severity of symptoms.
Some of the other possible causes include:
Summary
While you might want to check yourself for hiatal hernia, imagine tests are almost always needed to make a diagnosis. Such studies might include X-rays, barium swallow tests, CT scans, or endoscopies. Other tests include esophageal manometry and pH monitoring.
Once a hiatal hernia is diagnosed, it can be classified into one of four types. Most hiatal hernias are type 1, in which the stomach stays in its usual place, and the hole in the diaphragm sometimes allows a portion of the stomach to slip into it. A healthcare provider will classify the type, perform a differential diagnosis to exclude other causes, and then discuss a treatment option.
How a Hiatal Hernia Is Treated
4 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Farhat A, Towle D.Incidental hiatal hernia on chest x-ray.JETem. 2018;3(3). doi:10.21980/J8KP8SSfara A, Dumitrascu DL.The management of hiatal hernia: an update on diagnosis and treatment.Med Pharm Rep. 2019;92(4):321-325. doi:10.15386/mpr-1323University of Michigan Health.Hiatal hernias.Roman, S.The diagnosis and management of hiatus hernia.BMJ.2014; 349:g6154. doi:10.1136/bmj.g6154.
4 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Farhat A, Towle D.Incidental hiatal hernia on chest x-ray.JETem. 2018;3(3). doi:10.21980/J8KP8SSfara A, Dumitrascu DL.The management of hiatal hernia: an update on diagnosis and treatment.Med Pharm Rep. 2019;92(4):321-325. doi:10.15386/mpr-1323University of Michigan Health.Hiatal hernias.Roman, S.The diagnosis and management of hiatus hernia.BMJ.2014; 349:g6154. doi:10.1136/bmj.g6154.
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Farhat A, Towle D.Incidental hiatal hernia on chest x-ray.JETem. 2018;3(3). doi:10.21980/J8KP8SSfara A, Dumitrascu DL.The management of hiatal hernia: an update on diagnosis and treatment.Med Pharm Rep. 2019;92(4):321-325. doi:10.15386/mpr-1323University of Michigan Health.Hiatal hernias.Roman, S.The diagnosis and management of hiatus hernia.BMJ.2014; 349:g6154. doi:10.1136/bmj.g6154.
Farhat A, Towle D.Incidental hiatal hernia on chest x-ray.JETem. 2018;3(3). doi:10.21980/J8KP8S
Sfara A, Dumitrascu DL.The management of hiatal hernia: an update on diagnosis and treatment.Med Pharm Rep. 2019;92(4):321-325. doi:10.15386/mpr-1323
University of Michigan Health.Hiatal hernias.
Roman, S.The diagnosis and management of hiatus hernia.BMJ.2014; 349:g6154. doi:10.1136/bmj.g6154.
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