A hiatal hernia can cause symptoms alarming enough to make you think you might have something much more serious.

An upper endoscopy is often done to check for a hiatal hernia, and sometimes, a hiatal hernia is discovered incidentally — meaning, the procedure was done for an unrelated reason.

Though small-enough hernias won’t cause symptoms, larger ones can cause any of the following:

• Heartburn or chest discomfort

• Regurgitation of food or liquids into the mouth

• Acid reflux (acid escapes from the stomach into the esophagus)

• A sensation of trouble getting food down (though it’ll always go down; it’ll never get trapped).

• Abdominal discomfort

• Feeling full soon after eating

• A sensation of trouble breathing or not getting enough air

• Small amount of blood in bowel movements

If you suspect a hiatal hernia based on your symptoms, you may be wondering how reliable an upper endoscopy would be at detecting the condition.

“Yes, endoscopy can easily miss small hiatal hernias,” says Santosh Sanagapalli, MD, a consultant gastroenterologist, endoscopist and specialist in esophageal disorders.

“The most common type of hiatal hernia is the sliding hiatal hernia.

“As the name implies, the exact position and size of the hernia in this subtype changes, as the lower esophageal sphincter complex ‘slides’ up and down within the diaphragmatic hiatus.

“Therefore, the hernia can be smaller and larger at times, and at some times may not be easily visible.

“Further, improper distension of the area with gas [induced by the doctor performing the endoscopy to enhance viewing] may render small hiatal hernias not visible.

“I cannot put a percentage on it, but certainly any hiatus hernia <3 cm in length could easily be missed on an endoscopy. Larger hernias than this should always be seen on endoscopy.

“The same limitation applies to barium swallow, and small hernias could be missed there too.”

Is there a better test?

“The most accurate test for identifying the size and location of a hiatus hernia is esophageal manometry,” says Dr. Sanagapalli.

“Esophageal manometry is a test performed in patients with swallowing problems and reflux symptoms that uses a catheter (thin tube) to measure pressures within the esophagus.

“As it provides a real-time measurement of pressure signals arising from both the lower esophageal sphincter and diaphragm, esophageal manometry performed by an experienced practitioner will always be able to identify a hiatal hernia, with 100% accuracy.”

Dr. Sanagapalli is a gastroenterologist and director of the Esophageal Disorders Center at St Vincent’s Hospital, Darlinghurst. He performs diagnostic and therapeutic endoscopic procedures, and enjoys providing comprehensive and holistic care to patients with a wide variety of disorders affecting the gastrointestinal tract.
Lorra Garrick has been covering medical, fitness and cybersecurity topics for many years, having written thousands of articles for print magazines and websites, including as a ghostwriter. She’s also a former ACE-certified personal trainer.



Top image: Shutterstock/George Rudy