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
For symptomatic hiatal hernias, consider the following:
- Peptic ulcer disease
- Acute coronary syndrome
- Coronary artery disease
- Achalasia (see esophageal motility disorder)
- Esophageal web / esophageal ring
- Esophageal spasm (see esophageal motility disorder)
- Mesenteric ischemia
- Malignancy (particularly esophageal, gastric, small bowel, pancreatic, liver)
- Biliary colic / cholelithiasis
- 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