In a patient with longstanding/severe symptoms, the hernia may be large and/or of a paraesophageal type necessitating corrective surgery. In some cases, hiatal hernias may be associated with a shortened length of thoracic esophagus above the hernia, necessitating an esophageal lengthening procedure (eg, Collis gastroplasty) for successful treatment [21]. Size, subtype of the hernia, and severity of symptoms drive treatment, which ranges from medical management to corrective surgery [20]. CT Abdomen and Pelvis There is no relevant literature to support the use of CT abdomen and pelvis for initial imaging for hiatal hernia. CT Abdomen There is no relevant literature to support the use of CT abdomen for initial imaging for hiatal hernia. CT Abdomen Multiphase There is no relevant literature to support the use of multiphase CT for initial imaging for hiatal hernia. FDG-PET/CT Skull Base to Mid-Thigh There is no relevant literature to support the use of FDG-PET/CT for initial imaging for hiatal hernia. Fluoroscopy Biphasic Esophagram Although endoscopy can be used to diagnose a hiatal hernia based on the site of the gastroesophageal junction and diaphragmatic impression on the esophagus, barium studies provide a more accurate depiction of the anatomic features of the hernia and also enable better determination of other factors that contribute to reflux symptoms, including the size of the hiatal hernia, opening of the gastroesophageal junction, and loss of the angle of Hiss [6,21- 23]. Barium studies also are better than endoscopy for differentiating sliding hiatal hernias from paraesophageal hernias [6]; this distinction is important because the surgical approach for treating a paraesophageal hernia is different from a sliding hiatal hernia [21,23]. The importance of imaging in this context is reflected in the Epigastric Pain
Epigastric Pain. In a patient with longstanding/severe symptoms, the hernia may be large and/or of a paraesophageal type necessitating corrective surgery. In some cases, hiatal hernias may be associated with a shortened length of thoracic esophagus above the hernia, necessitating an esophageal lengthening procedure (eg, Collis gastroplasty) for successful treatment [21]. Size, subtype of the hernia, and severity of symptoms drive treatment, which ranges from medical management to corrective surgery [20]. CT Abdomen and Pelvis There is no relevant literature to support the use of CT abdomen and pelvis for initial imaging for hiatal hernia. CT Abdomen There is no relevant literature to support the use of CT abdomen for initial imaging for hiatal hernia. CT Abdomen Multiphase There is no relevant literature to support the use of multiphase CT for initial imaging for hiatal hernia. FDG-PET/CT Skull Base to Mid-Thigh There is no relevant literature to support the use of FDG-PET/CT for initial imaging for hiatal hernia. Fluoroscopy Biphasic Esophagram Although endoscopy can be used to diagnose a hiatal hernia based on the site of the gastroesophageal junction and diaphragmatic impression on the esophagus, barium studies provide a more accurate depiction of the anatomic features of the hernia and also enable better determination of other factors that contribute to reflux symptoms, including the size of the hiatal hernia, opening of the gastroesophageal junction, and loss of the angle of Hiss [6,21- 23]. Barium studies also are better than endoscopy for differentiating sliding hiatal hernias from paraesophageal hernias [6]; this distinction is important because the surgical approach for treating a paraesophageal hernia is different from a sliding hiatal hernia [21,23]. The importance of imaging in this context is reflected in the Epigastric Pain