A hiatal hernia occurs when a portion of the stomach pushes upward through an opening in the diaphragm, the muscular wall separating the chest from the abdomen. This causes the stomach to bulge into the chest. Understanding how these hernias are measured helps define a “large” hiatal hernia.
Understanding Hiatal Hernias
Hiatal hernias are categorized into different types based on how the stomach protrudes through the diaphragm’s opening, known as the hiatus. The most common form is the sliding hiatal hernia. In this type, the gastroesophageal junction, where the esophagus meets the stomach, and a part of the stomach slide up into the chest through the hiatus.
Less common are paraesophageal hiatal hernias. In these cases, a portion of the stomach pushes up into the chest alongside the esophagus. Paraesophageal hernias can be more serious because they involve the stomach or other abdominal organs becoming trapped or twisted.
Measuring Hiatal Hernia Size
Medical professionals use various methods to measure the size of a hiatal hernia. Endoscopy is a common diagnostic tool, where a flexible tube with a camera is inserted down the throat to visualize the esophagus and stomach. During this procedure, the distance the gastroesophageal junction has moved above the diaphragm can be measured.
Imaging techniques, such as a barium swallow or computed tomography (CT) scans, provide insights into hernia size and location. A barium swallow involves drinking a contrast liquid that highlights the esophagus and stomach on X-ray images. CT scans offer detailed cross-sectional images, assessing the hernia’s dimensions and the width of the hiatal opening.
What Constitutes a Large Hiatal Hernia?
Defining a “large” hiatal hernia involves specific measurements of stomach protrusion into the chest. While no universal standard exists, a hiatal hernia is considered large when the stomach protrudes 3 centimeters or more above the diaphragm. Some definitions categorize hernias as large at 5 centimeters or greater.
A 2022 study proposed that a sliding hiatal hernia measuring 7 centimeters or more, or involving over 50% of the stomach protruding into the chest, is considered large. In paraesophageal hernias, “large” can also refer to cases where a significant portion of the stomach, or even other abdominal organs like the spleen or pancreas, enters the chest cavity. These extensive protrusions indicate a larger hiatal opening and a greater degree of herniation.
Clinical Significance of Large Hiatal Hernias
The size of a hiatal hernia impacts its clinical significance and health implications. Larger hernias are more likely to cause severe symptoms, including persistent acid reflux, heartburn, difficulty swallowing, chest pain, nausea, and bloating.
Large hiatal hernias carry a higher risk of complications. Chronic acid reflux, if left unmanaged, can lead to esophagitis (inflammation of the esophagus), esophageal strictures (narrowing due to scarring), and conditions like Barrett’s esophagus. More serious complications, especially with paraesophageal types, include gastric volvulus (twisting of the stomach), incarceration (where the stomach gets stuck), or strangulation (a cut-off blood supply to the herniated tissue).