The diagnosis and management of hiatus hernia

#### Summary points Hiatus hernia is a condition involving herniation of the contents of the abdominal cavity, most commonly the stomach, through the diaphragm into the mediastinum. In the United States, hiatus hernia was listed as a primary or secondary cause of hospital admissions in 142 of 10 000 inpatients between 2003 and 2006.1 However, the exact prevalence of hiatus hernia is difficult to determine because of the inherent subjectivity in diagnostic criteria. Consequently, estimates vary widely—for example, from 10% to 80% of the adult population in North America.2 It is, however, accepted that the prevalence of hiatus hernia parallels that of obesity and that it increases with age. The typical symptom of hiatus hernia is gastroesophageal reflux (heartburn, regurgitation). Less common symptoms are dysphagia, epigastric or chest pain, and chronic iron deficiency anaemia. This clinical review summarises the current evidence for the diagnosis and management of hiatus hernia. #### Sources and selection criteria We based this review on articles identified through a search of PubMed using the term “hiatal hernia” on 12 August 2014. Largely because of the extensive literature on reflux disease and the overlap between reflux disease and hiatus hernia, the search returned over 4500 citations, even when limited to publications in the English …