From the Guidelines
Hiatal Hernia and Pulmonary Function Test (PFT) Obstruction
A hiatal hernia can indeed cause moderate obstruction on a Pulmonary Function Test (PFT), particularly if the hernia is large and compresses the lower esophagus, thereby triggering gastroesophageal reflux disease (GERD) symptoms 1.
- The symptoms of hiatal hernia can be nonspecific and may include gastrointestinal (GI) and respiratory symptoms, such as dyspnea and abdominal pain 1.
- In some cases, patients with hiatal hernia may exhibit a forced expiratory volume in one second (FEV1) to forced vital capacity (FVC) ratio of less than 70%, indicative of obstructive lung disease.
- Treatment with proton pump inhibitors, such as omeprazole 20mg twice daily for 8 weeks, may help alleviate GERD symptoms and subsequently improve PFT results, although the degree of improvement can vary depending on the individual case.
- It is essential to note that the effects of diaphragmatic rupture, including hiatal hernia, can result in a 25-50% decrease in pulmonary function, leading to respiratory symptoms such as dyspnea 1.
- The natural history of traumatic diaphragmatic injury with hernia formation has been described to have three phases, including the acute phase, the latent phase, and the obstructive phase, which can help guide the diagnosis and management of hiatal hernia 1.
From the Research
Hiatal Hernia and Pulmonary Function Test (PFT) Obstruction
- A hiatal hernia can cause moderate obstruction on a Pulmonary Function Test (PFT) due to lung compression, as described in studies 2, 3, 4.
- The size of the hiatal hernia can impact the degree of pulmonary function improvement after surgical repair, with larger hernias associated with greater improvement 4.
- Patients with moderate and severe preoperative pulmonary obstruction can demonstrate significant improvement in forced expiratory volume in 1 second (FEV1) after hiatal hernia repair 4.
- Hiatal hernias can also lead to gastric volvulus, obstruction, strangulation, and perforation, emphasizing the importance of managing large hiatal hernias to avoid such complications 5.
Pulmonary Function Improvement after Hiatal Hernia Repair
- Surgical repair of hiatal hernias can improve pulmonary function, as measured by forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), and total lung capacity (TLC) 2, 3.
- A systematic review and meta-analysis found that surgical repair of hiatal hernias significantly improved FEV1, FVC, and TLC, but had little effect on residual volume and diffusing capacity of lung for carbon monoxide (DLCO) 3.
- Another study found that spirometry results improved in 80% of patients after hiatal hernia repair, with 21% showing an improvement of >20% compared to preoperative levels 4.
Clinical Presentation and Esophageal Function
- The presence and size of a hiatal hernia can influence clinical presentation, esophageal function, reflux profile, and degree of mucosal injury in patients with gastroesophageal reflux disease (GERD) 6.
- Patients with larger hiatal hernias had more frequent episodes of coughing and wheezing associated with episodes of reflux, and high-resolution manometry showed decreasing pressure of the lower esophageal sphincter and weaker peristalsis 6.