Hiatal Hernia and Gastroesophageal Reflux (HH / GER)

Michael P. D'Alessandro, M.D.
Peer Review Status: Internally Peer Reviewed

Etiology/Pathophysiology:
The hiatal hernia and accompanying shortened esophagus are probably caused by reflux esophagitis and cicatrical traction on the gastroesophageal junction and stomach.. In kids most hiatal hernias are the sliding type with variable amounts of stomach passing through the esophageal hiatus into the chest. This impairs the competency of the gastroesophageal sphincter, producing gastroesophageal reflux. A paraesophageal hernia is one in which part of greater curvature of the stomach passes through the hiatus beside a normally placed gastroesophageal junction. Complications seen in a hiatal hernia include aspiration pneumonia and peptic esophagitis with stricture.

Pathology:
Not applicable

Imaging Findings:
On abdominal plain films, large hernias are seen as retrocardiac densities or lucencies that may have air fluid levels.

Upper GI can show reflux and the variable degrees of gastric herniation, esophagitis, and esophageal strictures.

DDX:

• Not applicable

References:
See References Chapter.

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