From the Guidelines
The gold standard investigation tool for hiatal (esophageal) hernia is Fluoroscopy biphasic esophagram.
Key Points
- This diagnostic tool provides anatomic and functional information on esophageal length, esophageal stricture, presence of gastroesophageal reflux, and reflux esophagitis 1.
- A combined technique of single-contrast and double-contrast examinations is most favorable for assessing hiatal hernia, with a reported sensitivity of 88% for detecting endoscopically proven esophagitis 1.
- Upper GI series evaluation should be included for complete assessment of the stomach, especially if the hiatal hernia is large 1.
- While upper endoscopy is useful for inspecting for erosive esophagitis, diaphragmatic hiatus, and Barrett’s esophagus, it is not the primary diagnostic tool for hiatal hernia 1.
- Barium esophagram is an alternative diagnostic tool that provides similar information to fluoroscopy biphasic esophagram, but the latter is considered the gold standard 1.
From the Research
Diagnostic Tools for Hiatal Hernia
The gold standard investigation tool for hiatal (esophageal) hernia is a topic of discussion among various studies. The following points highlight the key findings:
- Endoscopy is often considered a reliable method for diagnosing hiatal hernias, but its sensitivity and specificity vary compared to other diagnostic tools 2, 3.
- High-resolution manometry (HRM) has been shown to have high sensitivity and specificity for detecting hiatal hernias, with some studies suggesting it is superior to endoscopy and radiology 4, 5, 6.
- A study comparing HRM, endoscopy, and radiology found that HRM had the highest diagnostic accuracy for hiatal hernia detection, with a sensitivity of 92% and specificity of 95% 6.
- Another study found that HRM was superior to endoscopy and radiology in assessing and grading sliding hiatal hernia, with a diagnostic sensitivity and specificity of 94.3% and 91.5%, respectively 5.
Comparison of Diagnostic Tools
The following points compare the diagnostic tools:
- Endoscopy vs. HRM: HRM has been shown to have higher sensitivity and specificity than endoscopy for detecting hiatal hernias 3, 6.
- HRM vs. Radiology: HRM has been found to be superior to radiology in detecting hiatal hernias, with higher sensitivity and specificity 4, 5.
- HRM vs. Endoscopy and Radiology: HRM has been shown to have the highest diagnostic accuracy for hiatal hernia detection, exceeding the sensitivity of endoscopy and radiography alone 6.
Key Findings
The key findings of the studies are:
- HRM is a reliable diagnostic tool for detecting hiatal hernias, with high sensitivity and specificity 4, 5, 6.
- Endoscopy and radiology may not be the best methods for diagnosing hiatal hernias, with lower sensitivity and specificity compared to HRM 3, 4.
- HRM can accurately assess the presence and size of hiatal hernias, with good agreement between HRM, endoscopy, and radiography for size assessment 6.