A hernia occurs when an organ or tissue pushes through the muscle wall or membrane that normally contains it. Gastroenterologists (GIs) specialize in disorders affecting the digestive tract, from the esophagus to the rectum. While general surgeons manage most abdominal wall hernias, a GI specialist frequently diagnoses hernias impacting the upper digestive system, such as a hiatal hernia. This type occurs when the upper part of the stomach pushes up through the opening in the diaphragm.
The Gastroenterologist’s Role in Abdominal Diagnosis
Patients frequently see a gastroenterologist first because hernia symptoms often mimic common digestive disorders. A hiatal hernia can cause chronic heartburn, regurgitation, and difficulty swallowing, symptoms also associated with gastroesophageal reflux disease (GERD) or peptic ulcers. The GI specialist investigates these digestive complaints to determine the underlying cause.
The hiatal hernia is the type most commonly identified in a gastroenterologist’s practice due to its location at the junction of the esophagus and stomach. Other hernias, such as umbilical or inguinal hernias, are typically diagnosed by a primary care physician or surgeon. However, these may be incidentally noted during imaging studies ordered by the GI specialist, whose expertise lies in assessing the functional consequences of the protrusion on digestive organs.
The diagnostic process begins with a detailed review of the patient’s symptoms, including specific questions about when pain or reflux occurs. The specialist attempts to rule out non-hernia conditions like esophagitis or inflammatory bowel disease. This systematic evaluation of digestive distress frequently leads to the discovery of a hiatal hernia as the source of the patient’s discomfort.
Diagnostic Procedures for Identifying Hernias
The gastroenterologist employs specialized tools to confirm the presence and assess the impact of a suspected hernia. A physical examination offers limited insight for internal hernias, but can reveal external masses in the case of an abdominal wall hernia. The most definitive diagnostic tool for an internal hernia is typically an upper GI endoscopy, also known as an EGD.
During an EGD, the GI specialist inserts a thin, flexible tube equipped with a light and camera down the throat. This allows visual examination of the lining of the esophagus and stomach. For a hiatal hernia, the endoscope allows the physician to directly observe the stomach tissue protruding above the diaphragm. This confirmation also helps assess the severity of associated damage, such as inflammation or erosions caused by chronic acid exposure.
Imaging studies provide a clear picture of the hernia’s anatomy. A barium swallow, or upper GI series, involves the patient drinking a liquid that coats the digestive tract. X-rays are taken as the patient swallows, outlining the shape and location of the stomach and esophagus. This reveals the characteristic pouching of the stomach into the chest cavity.
Computed tomography (CT) scans may be ordered if the diagnosis is unclear or if the hernia is discovered incidentally. Although not the first-line test for a hiatal hernia, CT scans offer a detailed cross-sectional view of the abdomen and chest. This advanced imaging is effective for visualizing the size and contents of the hernia sac and identifying potential complications.
The Referral Pathway Following Diagnosis
Once a gastroenterologist confirms a hernia diagnosis, the care pathway shifts to treatment, involving collaboration with a surgical specialist. The definitive treatment for most symptomatic hernias is surgical repair, performed by a general surgeon. The GI specialist facilitates a seamless transfer of care to the appropriate surgical team.
The gastroenterologist may continue to manage symptoms while the patient awaits a surgical consultation, particularly for hiatal hernias causing significant reflux. This management often involves prescribing medications like proton pump inhibitors (PPIs) to reduce stomach acid production. This medical management helps stabilize the patient’s condition and improve comfort.
The decision to refer for surgery depends on the hernia’s size, the severity of symptoms, and the risk of complications like strangulation. For small, asymptomatic hernias, the GI specialist might recommend a “watchful waiting” approach. However, any signs of an incarcerated hernia, where the tissue is trapped, prompt an immediate surgical referral due to the risk of tissue death.