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Hiatal hernia
Other Resources UpToDate PubMed

Hiatal hernia

Contributors: Michael W. Winter MD, Christine Osborne MD, Desiree Rivera-Nieves MD, Khaled Bittar MD, Nishant H. Patel MD
Other Resources UpToDate PubMed


A hiatal hernia occurs when the esophageal hiatus of the diaphragm widens, creating a hernia cavity that can contain abdominal cavity contents, most typically the stomach. In larger hernias, parts of the large and small bowel can herniate through the esophageal hiatus.

Hiatal hernias are typically asymptomatic. On occasion, patients will complain of vague abdominal discomfort. However, in most instances, they are diagnosed incidentally on cross-sectional imaging or upper endoscopy.

Hiatal hernias are classified as sliding or paraesophageal:
  • Type I: sliding hernia – Most common type, due to progressive weakening of the gastroesophageal junction allowing a portion of the gastric cardia to slide upward with increased abdominal pressure, swallowing, and respiration. Patients with type I hernias are more likely to have gastroesophageal reflux disease (GERD).
  • Types II, III, IV: paraesophageal hernia – Herniation includes viscera other than the gastric cardia, including gastric fundus and the colon. In type II and III hernias, the stomach becomes "inverted," possibly leading to gastric volvulus.


K44.9 – Diaphragmatic hernia without obstruction or gangrene
Q40.1 – Congenital hiatus hernia

84089009 – Hiatal Hernia

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Differential Diagnosis & Pitfalls

Most hiatal hernias are asymptomatic and are anatomic diagnoses.

For symptomatic hiatal hernias, consider the following:
  • Peptic ulcer disease
  • Gastritis
  • Acute coronary syndrome
  • Coronary artery disease
  • Esophagitis
  • Achalasia (see Esophageal motility disorder)
  • Esophageal web / Schatzki ring
  • Esophageal spasm (see Esophageal motility disorder)
  • Gastroparesis
  • Gastroenteritis
  • Chronic mesenteric ischemia
  • Malignancy (particularly Esophageal carcinoma, Gastric cancer, small bowel, Pancreatic carcinoma, Liver cancer)
  • Biliary colic / Biliary calculus
  • Zollinger-Ellison syndrome
  • Chronic pancreatitis
  • Drug side effects (NSAIDs, alcohol, caffeine, antibiotics, corticosteroids, opiates, digoxin)
  • Inflammatory bowel disease (Ulcerative colitis, Crohn disease)
  • Irritable bowel syndrome

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Last Reviewed:12/18/2016
Last Updated:09/16/2020
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Hiatal hernia
A medical illustration showing key findings of Hiatal hernia : Nausea, Epigastric pain, Dysphagia, Dyspepsia, Regurgitation
Imaging Studies image of Hiatal hernia - imageId=7915932. Click to open in gallery.  caption: '<span>Image from a CT scan of the abdomen demonstrating a large hiatal hernia.</span>'
Image from a CT scan of the abdomen demonstrating a large hiatal hernia.
Copyright © 2024 VisualDx®. All rights reserved.