Clinical Review

The diagnosis and management of hiatus hernia

BMJ 2014; 349 doi: https://doi.org/10.1136/bmj.g6154 (Published 23 October 2014) Cite this as: BMJ 2014;349:g6154
  1. Sabine Roman, associate professor1,
  2. Peter J Kahrilas, professor2
  1. 1Digestive Physiology, Hospices Civils de Lyon, Lyon I University, and Labtau, INSERM 1032, Lyon, France
  2. 2Department of Medicine, Division of Gastroenterology, Northwestern University, Chicago, IL 60611-2951, USA
  1. Correspondence to: P J Kahrilas p-kahrilas{at}northwestern.edu

Summary points

  • Hiatus hernia refers to herniation of the contents of the abdominal cavity, most commonly the stomach, through the esophageal hiatus of the diaphragm into the mediastinum

  • The prevalence of hiatus hernia increases with age and body mass index

  • In the absence of symptoms, there is no indication to diagnose or treat hiatus hernia

  • Gastroesophageal reflux disease is the main clinical manifestation of hiatus hernia

  • Endoscopy, radiology with barium swallow, or high resolution manometry can detect most cases of hiatus hernia

  • Surgical treatment of hiatus hernia, usually coupled with an antireflux procedure, can be complicated, making a critical risk-benefit assessment mandatory

Hiatus hernia is a condition involving herniation of the contents of the abdominal cavity, most commonly the stomach, through the diaphragm into the mediastinum. In the United States, hiatus hernia was listed as a primary or secondary cause of hospital admissions in 142 of 10 000 inpatients between 2003 and 2006.1 However, the exact prevalence of hiatus hernia is difficult to determine because of the inherent subjectivity in diagnostic criteria. Consequently, estimates vary widely—for example, from 10% to 80% of the adult population in North America.2 It is, however, accepted that the prevalence of hiatus hernia parallels that of obesity and that it increases with age. The typical symptom of hiatus hernia is gastroesophageal reflux (heartburn, regurgitation). Less common symptoms are dysphagia, epigastric or chest pain, and chronic iron deficiency anaemia. This clinical review summarises the current evidence for the diagnosis and management of hiatus hernia.

Sources and selection criteria

We based this review on articles identified through a search of PubMed using the term “hiatal hernia” on 12 August 2014. Largely because of the extensive literature on reflux disease and the overlap between reflux disease and hiatus hernia, the search returned over 4500 citations, even when limited to publications in the English …

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