A hiatal hernia occurs when a portion of the stomach bulges upward into the chest cavity through an opening in the diaphragm. This condition develops when the esophageal hiatus, the opening in the diaphragm through which the esophagus passes, widens, allowing part of the stomach to push through.
Chest X-rays and Hiatal Hernia Indication
A routine chest X-ray can sometimes reveal a hiatal hernia, especially if large. It may appear as a mass behind the heart, sometimes with an air-fluid level indicating trapped air and fluid. The absence of a typical stomach air bubble below the left diaphragm can also suggest stomach movement into the chest.
However, a chest X-ray is not a primary or definitive diagnostic tool. Its two-dimensional nature makes distinguishing a hiatal hernia from other chest structures challenging. Small hernias are often not clearly visible due to limited detail and tissue overlap.
X-rays are often performed for other reasons, and a hiatal hernia discovery is frequently incidental. While an X-ray provides an initial indication, further specialized tests are needed to confirm diagnosis and assess characteristics.
Specialized Diagnostic Procedures
When a hiatal hernia is suspected, specialized diagnostic procedures confirm and evaluate its extent. A common method is a barium swallow (esophagram or upper GI series). Patients drink a barium liquid, coating the esophagus and stomach for X-ray visibility.
The barium swallow allows radiologists to observe barium movement through the upper digestive tract, providing detailed images. It helps identify stomach protrusion through the diaphragm, assess hernia size, and detect abnormalities.
An accurate diagnostic tool is an upper gastrointestinal endoscopy. This involves inserting a thin, flexible tube with a camera (endoscope) down the throat into the esophagus and stomach. Endoscopy provides direct visualization of the digestive tract’s lining, allowing doctors to see the hernia, evaluate the esophagus-diaphragm distance, and check for inflammation.
Esophageal manometry and pH studies assess associated conditions like gastroesophageal reflux disease (GERD). Manometry measures esophageal muscle pressure and coordination during swallowing, identifying motility issues. pH monitoring checks for stomach acid in the esophagus over time, often linked to hiatal hernias.
Recognizing Symptoms of a Hiatal Hernia
Many individuals with a hiatal hernia do not experience symptoms, and the condition may be discovered incidentally during unrelated exams. When symptoms occur, they relate to the backflow of stomach contents and acid into the esophagus, leading to a burning sensation in the chest, commonly known as heartburn, especially after eating or when lying down.
Other common symptoms include acid reflux (stomach acid rising into the esophagus) and regurgitation (the backflow of food or liquids). Some individuals may experience difficulty swallowing, a feeling of food getting stuck, or a lump in the throat. Chest pain, sometimes mistaken for heart issues, bloating, and frequent burping are also possible. In rare instances, a large hiatal hernia might cause shortness of breath if it puts pressure on the lungs. Consult a healthcare professional if symptoms are persistent or concerning.