Your doctor may discover a hiatal hernia while trying to determine the cause of heartburn or chest or upper abdominal pain. Diagnosis of hiatal hernia is based on typical clinical features and on the results of laboratory studies and procedures. You can start to diagnose a hiatal hernia first be seeing your family doctor, and you can then seek help from a hernia / internal medicine specialist if necessary. In fact, most hernias around the world are repaired by 'general' surgeons.
Hiatal hernia is diagnosed based on typical clinical features and the results of the following laboratory studies and procedures:
Acid perfusion (Bernstein) test - The Bernstein test can confirm the cause of heartburn as originating from esophageal reflux. Passing hydrogen chloride through the nasogastric (NG) tube can provoke the symptom and confirm a diagnosis.
Barium X-ray - During this test, you'll drink a chalky liquid containing barium that coats your upper digestive tract. This provides a clear silhouette of your esophagus, stomach and the upper part of your small intestine (duodenum) on an X-ray. A barium X-ray may help reveal whether the contents of your stomach are backing up into your esophagus. Furthermore, a hernia may appear as a pouch containing barium at the lower end of the esophagus. Small hernias, however, are difficult to recognize. This procedure also shows diaphragmatic abnormalities.
Chest X-ray - An x-ray can occasionally indicate a large hernia and recognizes aspiration in the lower lobes.
Endoscopy - During an endoscopy, your doctor passes a thin, flexible tube equipped with a fiber-optic light and video camera system (endoscope) down your throat and into your esophagus and stomach to check for inflammation. This not only can help detect a hiatal hernia, but also is the most sensitive way to check for damage to your esophagus from acid reflux. An endoscopy can also differentiate among hiatal hernia, varices, and other small gastroesophageal lesions and can rule out cancerous malignancy that otherwise may be difficult to detect.
Esophageal motility - This specific procedure studies assess the presence of esophageal motor abnormalities before surgical repair of the hernia.
pH studies - A pH study will assess for reflux of gastric contents.
Complications of hiatal hernia are generally secondary conditions, symptoms, or other disorders that are caused by the hernia. In many cases, the distinction between symptoms of hiatal hernia and complications of the hernia are unclear or arbitrary. Another severe complication, although very rare, is a large herniation that can restrict lung function, causing pain, and breathing problems. The following laboratory tests may indicate GI bleeding as a complication of hiatal hernia:
1. Analysis of gastric contents may reveal blood.
2. Complete blood count may show hypochromic microcytic anemia when bleeding from esophageal ulceration occurs.
3. Stool guaiac test may be positive.
Most hiatal hernias usually do not require treatment. However, untreated hernias can cause pain and health problems or can trigger other complications. Read here to learn more about hiatal hernia treatment options, including diet for hiatal hernia in the Treating Hiatal Hernia section that follows.
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