How are hiatal and paraesophageal hernias diagnosed and evaluated?
- Paraesophageal hernias are often first suspected because of a chest radiograph abnormality.
- Classically a retrocardiac air bubble with or without an air-fluid level will be present.
- Confirmation can be obtained with a barium swallow, which shows the typical appearance of a large intrathoracic stomach and evaluates the motility of the esophagus simultaneously.
- Upper endoscopy is useful to evaluate the distal esophagus and stomach for ulcers, erosions, Barrett’s esophagus, or neoplasms in this generally older population.
- An esophageal motility study is recommended in patients being considered for elective surgical correction of a paraesophageal hernia both to determine the status of the LES and to assess the function of the esophageal body.
- This is particularly true in any patient with symptoms of dysphagia. A 24-hour pH test is usually not necessary because a fundoplication is recommended as part of the procedure to correct this defect.
