What is a hiatal hernia?
A hiatal hernia is a herniation of abdominal contents into the chest cavity. Usually this occurs through the esophageal hiatus or opening where the esophagus passes through to meet the stomach.
Most commonly the hernia involves portions of the stomach but can include any of the abdominal contents to include colon, fat, and abdominal organs. This type of hernia occurs most commonly as one ages.
Sliding hiatal hernia
The most common type is called sliding where the hernia reduces or goes away when you stand. The junction of the stomach and esophagus is displaced upwards.
The rolling type of hernia is where the stomach herniates into the chest but the junction of the stomach and esophagus are in a normal location.
There are mixed types, and those that include other herniated abdominal contents.
Small versus large hiatal hernia symptoms
They can be small and asymptomatic to large and symptom causing to include chest pain, pain in the upper abdomen, reflux, nausea and vomiting.
The most feared complication is when the stomach in the hernia twists and causes a blockage and cut off of blood supply.
What does a hiatal hernia look like on esophagram?
On esophagram, you can see a piece of the stomach going above the diaphragm. The esophagram can also characterize whether it is a sliding or rolling type based on the position of the junction of the stomach and esophagram.
The esophagram can not however tell if there are other herniated abdominal contents. A CT scan is needed for that.
Would a hiatal hernia show on a barium swallow?
Yes, it often will. A barium swallow is another name for a barium esophagram.
Hernia on esophagram as an incidental finding
Hiatal hernias are often seen as incidental findings on esophagrams and other imaging tests like CT. This means we see the hernia but it is not necessarily the cause of your symptoms or the reasons for the test.
Hiatal hernia treatment
Those hernias which are large or symptomatic are often treated surgically. I see a lot of pre operative esophagrams where the surgeon wants to get a better look at the hernia with an esophagram.
If you develop pain, then it is important to get prompt treatment as there may be a complication. In all cases, it is important to have your hernia assessed and possibly treated by a surgeon.
Hiatal hernia on esophagram: summary
Hiatal hernias on esophagrams are common findings. They can cause symptoms like heart burn, pain, nausea, and vomiting. Esophagrams are often ordered to evaluate symptoms associated with a hernia. They are ordered before surgery for planning.