Hiatal Hernia - Diagnosis
CXR: A shadow behind the heart on a routine chest film is a common mode of discovery of paraesophageal hernia (see image below).
Videoesophagram: This study shows the anatomy of the gastroesophageal junction, the position of the stomach and the presence of other intra-abdominal organs in the chest. In addition, a videoesophagram reveals the esophageal emptying. A large paraesophageal hernia is shown on a barium esophagram in the image below.
Upper endoscopy: An upper endoscopy can reveal the presence of a hiatal hernia and allows an assessment of the damage to the lining of the esophagus and the stomach. The image below shows an endoscopic view of a sliding (type I) hiatal hernia.
The image below shows an endoscopic view of a type III hiatal hernia.
Esophageal motility study: This study measures the pressure in the lower esophageal sphincter (the valve between the esophagus and the stomach) and the function of the esophageal body.
Esophageal pH study: We routinely obtain a 24-hour esophageal pH study or a 48-hour Bravo capsule wireless pH study to detect the amount of acid in the esophagus in patients with symptomatic hiatal hernia and gastroesophageal reflux disease. We do not routinely perform a pH study in patients with large paraesophageal hernia, since the result will not change our management in symptomatic patients, and the placement of a catheter is challenging and uncomfortable for the patients.