What Tests Are Used to Diagnose Hiatal Hernias?

There isn't a gold standard test for determining whether you have a hernia

doctor and patient with chest pain
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You have heartburn as well as stomach pain, chest pain, sweating, and a sore throat, so your doctor decides to run some tests to diagnose hiatal hernias. You probably thought that you were having a heart attack, right? But those symptoms point to a hiatal hernia, a condition when the stomach pushes up into the chest through a hole in the diaphragm.

Diagnosis and Grading of Hiatal Hernias

When you are diagnosed with a hiatal hernia, it isn't simple.

There are two kinds and four types that fall within those perimeters. Here they are:

Sliding or type I hiatal hernia is the most common type. It occurs when the stomach moves in and out of the chest cavity, and a separation of 2 centimeters or more occurs between the esophagogastric junction, aka where the esophagus ends and the stomach begins, and diaphragm. This type is mostly associated with reflux disease, and it is most difficult to define, and therefore, diagnose.

Para-oesophageal or types II, III, IV hiatal hernias make up 5 to 15% of hiatal hernia diagnoses. They are also associated with reflux but have more to do with complications of your body's mechanics, usually within the tissues, ligament, membranes of the esophagus, stomach, and diaphragm.

Tests That Diagnose a Hiatal Hernia

The procedure used most often to detect a hiatal hernia is an upper endoscopy. It allows the doctor to examine the inside of the patient's esophagus, stomach, and duodenum (the first part of the small intestine) with an instrument called an endoscope, a thin flexible lighted tube.

With this procedure the doctor will be able to see if there is a hiatal hernia.

manometry of the esophagus may also be ordered, in conjunction with the upper endoscopy. It determines whether your esophagus is working properly by measuring the forces your esophagus muscles exert and the rhythm of their contractions as you swallow.

 

Another test is the barium swallow or an upper gastrointestinal series. During this procedure, the patient drinks a liquid that contains barium, which will coat the walls of the esophagus and stomach. X-rays are then taken, which can then show if there is a hiatal hernia. The problem with this test is that a diagnosis is dependent on the position of a sliding hernia during the test, which is why it is rarely used alone. 

The Bernstein Test attempts to reproduce symptoms of heartburn. It is usually done along with other tests dealing with esophageal functions. This test is also called the acid perfusion test. It isn't used alone to diagnose a hiatal hernia, but used in combination with barium x-rays can help determine if an associated condition also exists: Gastroesophageal Reflux Disease (GERD).

Singularly, these tests have flaws in their ability to diagnose hiatal hernias; however, when done together they can provide different information about what is going on between your esophagus, stomach, and diaphragm to help your physician figure out if a hiatal hernia is truly what ails you.

Sources:

Kahrilas PJ, Kim HC, Pandolfino JE. "Approaches to the Diagnosis and Grading of Hiatal Hernia." Best Pract Res Clin Gastroenterol. 2008; 244(4): 601-616. doi:10.1016/j.bpg.2007.12.007

Van Weyenberg SJB. "Diagnosis and Grading of Sliding Hiatal Hernia." VJGI-Endoscopy. 2013; 1(1): 117-119. doi:10.1016/S2212-0971(1370051-7

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