Differential Diagnosis for Hiatus Hernia
- Single most likely diagnosis
- A. Sliding HH: This is the most common type of hiatus hernia, accounting for about 90% of cases. The patient's symptoms of gastric upset, heartburn, dysphagia, and early satiety, along with the relief of discomfort after belching, are consistent with a sliding hiatus hernia. The fact that an upper endoscopy and barium study showed a hiatus hernia further supports this diagnosis.
- Other Likely diagnoses
- B. Achalasia with GORD: Although less likely, achalasia (a motility disorder of the esophagus) combined with gastroesophageal reflux disease (GORD) could present with similar symptoms. However, the primary symptom of achalasia is dysphagia to both liquids and solids, and the relief of symptoms after belching is not typical.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- C. Paraoesophageal hernia type II (true hernia): Although less common, a paraoesophageal hernia can lead to severe complications such as incarceration and strangulation of the herniated stomach, which can be life-threatening. The presence of severe symptoms or signs of obstruction would necessitate urgent evaluation.
- Rare diagnoses
- D. Rolling hernia type IV: This is a rare type of hiatus hernia where other organs like the colon, small intestine, or spleen can herniate through the esophageal hiatus. The symptoms can be non-specific and similar to other types of hernias, but the presence of other herniated organs would make it distinct. However, given the information provided, this diagnosis seems less likely compared to the others.