Esophageal Manometry: Understanding Hiatal Hernia Diagnosis

So you’ve been experiencing symptoms like heartburn, chest pain, and difficulty swallowing, and your doctor suspects you may have a hiatal hernia. But what exactly is a hiatal hernia, and how is it diagnosed? In this article, we’ll break it down for you and focus specifically on one of the diagnostic tests used – esophageal manometry. By understanding how this test works, you’ll be better equipped to understand your diagnosis and explore possible treatment options.

Examining patient for esophageal manometry
Examining patient for esophageal manometry

What is a Hiatal Hernia?

A hiatal hernia occurs when a part of the stomach pushes up through the diaphragm into the chest cavity. It is a relatively common condition that affects the upper part of the stomach and the lower part of the esophagus. This displacement of the stomach can lead to various symptoms and complications, and understanding its causes, types, and diagnostic procedures is crucial for proper diagnosis and treatment.


A hiatal hernia is defined as the protrusion of the stomach through the diaphragm, resulting in the stomach being positioned in the chest cavity. The diaphragm is a muscle that separates the chest cavity from the abdomen, and it helps with breathing by contracting and relaxing. When there is a weakened or enlarged opening in the diaphragm, the stomach can slip through, causing a hiatal hernia.


The exact cause of a hiatal hernia is often unknown, but certain factors may contribute to its development. One of the main causes is an anatomical weakness in the diaphragm, which can be present from birth or develop over time. Factors that increase the risk of developing a hiatal hernia include age, obesity, pregnancy, smoking, and conditions that increase pressure on the abdomen, such as persistent coughing or straining during bowel movements.

Types of Hiatal Hernia

There are two main types of hiatal hernias: sliding hiatal hernia and paraesophageal hernia.

  1. Sliding Hiatal Hernia: This is the most common type of hiatal hernia where the junction between the esophagus and the stomach slides up into the chest. The sliding hernia can vary in size and may come and go, depending on body position and swallowing.

  2. Paraesophageal Hernia: In this type, a portion of the stomach squeezes through a weakened diaphragmatic opening and remains in the chest permanently. This type of hernia is less common but poses a higher risk of complications due to the potential for the stomach to become “strangled” or twisted.

Symptoms and Complications

Recognizing the symptoms of a hiatal hernia is crucial for an accurate diagnosis and appropriate treatment. While some individuals may experience no symptoms, others may be troubled by a range of discomforts. Additionally, complications can arise, especially if the hernia is left untreated.

Common Symptoms

The symptoms associated with a hiatal hernia can vary depending on the size and type of hernia. Common manifestations include:

  • Heartburn: A burning sensation in the chest or throat, often accompanied by regurgitation of acid or food.
  • Chest pain: Discomfort or pain in the chest area, which can mimic the symptoms of a heart attack.
  • Difficulty swallowing: A feeling of food getting stuck in the throat or chest.
  • Reflux: Acidic stomach contents flowing back into the esophagus, leading to a sour taste in the mouth or the sensation of a lump in the throat.
  • Belching: Frequent burping or excessive gas.
  • Shortness of breath: Difficulty in breathing or a sensation of breathlessness, especially during physical activity.

Complications and Risks

If left untreated, a hiatal hernia can lead to complications. These can include:

  • Strangulation: In rare cases, a hiatal hernia can cause the blood supply to the herniated part of the stomach to be cut off, resulting in tissue damage.
  • Ulcers and bleeding: The presence of a hiatal hernia can contribute to the development of gastric ulcers or inflammation in the esophagus, leading to bleeding and anemia.
  • Barrett’s esophagus: Chronic inflammation due to acid reflux associated with a hiatal hernia can increase the risk of developing a condition called Barrett’s esophagus, which can further lead to a type of esophageal cancer.

It is essential to seek medical attention if you suspect you may have a hiatal hernia to prevent or address any potential complications.

Understanding Esophageal Manometry

Esophageal manometry is a diagnostic procedure used to assess the functionality and motility of the esophagus and lower esophageal sphincter (LES). By measuring the pressure and movement within the esophagus, this test helps in diagnosing disorders such as hiatal hernia and gastroesophageal reflux disease (GERD) and provides valuable information for treatment planning.


Esophageal manometry is a medical test that measures the muscular contractions and movement of the esophagus, as well as the pressure within the LES, which acts as a valve to prevent stomach acid from flowing back into the esophagus. The procedure involves the insertion of a thin, flexible tube equipped with sensors into the esophagus to evaluate its function.


The purpose of esophageal manometry is to assess how well the esophagus and LES are functioning. It helps determine the strength and coordination of the muscles involved in swallowing and how effectively the LES relaxes and contracts to allow food to enter the stomach. This information is essential in diagnosing hiatal hernias and other esophageal motility disorders.


During an esophageal manometry procedure, you will be asked to sit or lie down while a healthcare professional inserts a narrow, lubricated tube through your nose or mouth and into your esophagus. The tube is connected to a computerized device that measures the pressure changes in your esophagus as you swallow. The procedure takes about twenty minutes to complete and is generally well-tolerated, although you may experience some temporary discomfort or gagging sensation during the insertion.

Indications for Esophageal Manometry

Esophageal manometry is a valuable diagnostic tool in evaluating various esophageal disorders. Your doctor may recommend this procedure in the following situations:

When is it necessary?

  • Frequent heartburn or gastroesophageal reflux symptoms that are not completely relieved by medications.
  • Difficulty in swallowing, known as dysphagia, which may indicate an obstruction or motility disorder.
  • Suspected hiatal hernia or abnormalities in esophageal motility.
  • Evaluating the function of the LES and esophagus before surgical interventions such as fundoplication or hiatal hernia repair.

Conditions for Testing

Esophageal manometry may be indicated for suspected or confirmed conditions such as:

  • Hiatal hernia
  • Gastroesophageal Reflux Disease (GERD)
  • Esophageal motility disorders (e.g., achalasia, diffuse esophageal spasm)
  • Esophageal strictures or obstructions
  • Preoperative evaluation for anti-reflux surgery or hernia repair

Discussing your symptoms and medical history with your doctor will help determine if esophageal manometry is necessary in your specific case.

Preparing for Esophageal Manometry

Preparing for an esophageal manometry procedure is typically straightforward, but there are a few important steps you need to follow to ensure accurate results. These preparations usually involve dietary restrictions, temporarily discontinuing certain medications, and informing your doctor about any pre-existing conditions or concerns.

Dietary Restrictions

Your doctor will provide specific instructions for your dietary restrictions before the procedure. Typically, you will be advised to avoid eating or drinking for a certain period of time before the test. This empty stomach allows for better visualization and accurate assessment of esophageal function.

Medications to Avoid

Certain medications can interfere with esophageal manometry results, so it is important to inform your doctor about all the medications you are currently taking. This includes prescription medications, over-the-counter drugs, and herbal supplements. In some cases, you may need to temporarily discontinue medications such as proton pump inhibitors (PPIs), antacids, or specific heart medications for a period of time before the test.

Informing Your Doctor

Before the procedure, discuss any pre-existing conditions, allergies, or concerns with your doctor. Be sure to mention if you have a history of nosebleeds, difficulty swallowing, lung or heart problems, or if you are pregnant. These factors can affect the procedure and may require additional precautions or adjustments in the testing protocol.

The Esophageal Manometry Procedure

The esophageal manometry procedure involves the use of specialized equipment and sensors to measure various parameters related to esophageal and LES function. Understanding how the test is conducted can help alleviate any anxiety or uncertainty you may have.

Equipment Used

The equipment used in esophageal manometry typically consists of a flexible catheter or tube with multiple sensors along its length. These sensors measure the pressure changes within the esophagus and LES during swallowing or rest periods. The catheter is connected to a computerized system that records and analyzes the data in real-time.

Placement of Sensors

During the procedure, a healthcare professional will insert the catheter through your nose or mouth and guide it down into your esophagus. The sensors along the catheter are strategically positioned to accurately measure the pressure changes within the esophageal muscles and LES.

Measuring Muscle Contractions

Once the catheter is in place, you will be instructed to swallow small sips of water or a substance called barium, which helps visualize the movement of the esophagus during swallowing. The sensors on the catheter detect the muscle contractions and pressure changes as you swallow, providing valuable information about the coordination and strength of the esophageal muscles.

Testing for LES Function

In addition to monitoring the esophagus, esophageal manometry also assesses the functionality of the LES. The LES is located at the junction of the esophagus and stomach, and its proper functioning is crucial to prevent stomach acid from refluxing back into the esophagus. By measuring the pressure changes within the LES, the test can determine how well it opens and closes during swallowing and resting phases.

Interpreting the Results

The results of an esophageal manometry test are typically interpreted by a gastroenterologist or a healthcare professional trained in esophageal motility issues. Understanding how the test results are analyzed and what they mean can help guide discussions with your doctor and aid in developing an appropriate treatment plan.

Normal Findings

Normal results of an esophageal manometry test typically indicate that the esophagus is contracting and pushing food down to the stomach efficiently. The LES should relax appropriately during swallowing and maintain adequate resting pressure in between.

Abnormal Findings and Indications of Hiatal Hernia

Abnormal results from an esophageal manometry test may suggest various esophageal motility disorders, including hiatal hernia. Indications of a hiatal hernia may include:

  • Weak or ineffective esophageal contractions
  • Abnormal resting pressure in the LES
  • Reduced LES pressure during swallowing
  • Incoordination or incomplete relaxation of the LES

These findings, combined with other symptoms and medical history, contribute to the clinical diagnosis of a hiatal hernia and help guide further evaluation and treatment options.

Other Diagnostic Tests for Hiatal Hernia

In addition to esophageal manometry, other diagnostic tests may be utilized to confirm or evaluate a hiatal hernia further. These tests provide detailed images of the esophagus and stomach and can aid in distinguishing hiatal hernias from other disorders.


Endoscopy is a procedure that involves the insertion of a flexible tube with a camera and light source through the mouth and into the esophagus and stomach. This allows a direct visualization of the structures and can help identify the presence and characteristics of a hiatal hernia. Biopsies can also be taken during the procedure to rule out other conditions or to investigate any abnormalities.

Barium Swallow

A barium swallow is a radiographic procedure where you swallow a liquid containing barium, which coats the esophagus and stomach. X-rays are then taken while you swallow the liquid, allowing the radiologist to observe the shape, size, and movement of these structures. Barium swallow studies can reveal the presence, size, and sliding nature of a hiatal hernia.

CT Scan

A computed tomography (CT) scan may be ordered to obtain detailed cross-sectional images of the esophagus, stomach, and surrounding structures. CT scans provide comprehensive views of the anatomy and can help evaluate the severity of a hiatal hernia, as well as detect any associated complications like volvulus, in which the stomach becomes twisted.

Differential Diagnosis

Hiatal hernias can share similar symptoms with other conditions, making it important to differentiate them from other disorders. Certain conditions may mimic the symptoms of a hiatal hernia, and a thorough differential diagnosis can help ensure the correct diagnosis and subsequent treatment.

Conditions with Similar Symptoms

Conditions that may present with symptoms similar to a hiatal hernia include:

  • Gastroesophageal Reflux Disease (GERD): GERD is a condition where stomach acid regularly flows back into the esophagus, causing symptoms like heartburn and regurgitation. While hiatal hernias can contribute to GERD, they are not the sole cause.
  • Peptic Ulcer Disease: Ulcers in the stomach or duodenum can cause symptoms such as abdominal pain, heartburn, and difficulty swallowing, which may be mistaken for hiatal hernia symptoms.
  • Esophageal Motility Disorders: Conditions like achalasia or esophageal spasms can lead to swallowing difficulties and chest pain, which overlap with hiatal hernia symptoms.

Distinguishing Hiatal Hernia from Other Disorders

Distinguishing hiatal hernias from other disorders typically requires a combination of clinical evaluation, diagnostic tests, and medical history. Consultation with a healthcare professional is necessary to outline a comprehensive differential diagnosis and rule out other potential causes of your symptoms.

Discussing the Results with Your Doctor

Once you have completed your esophageal manometry and any other diagnostic tests, it is important to discuss the results with your doctor. This conversation will help you understand the findings, establish a diagnosis, explore treatment options, and address any concerns or lingering questions you may have.

Reviewing the Findings

Your doctor will review the results of your esophageal manometry and any other tests performed. They will explain what the findings mean in the context of your specific symptoms, and whether a hiatal hernia or any other condition has been identified. Understanding the significance of the results is vital in determining the next steps for your healthcare journey.

Treatment Options and Recommendations

Depending on the diagnosis and severity of your condition, your doctor will discuss appropriate treatment options and recommendations. Treatment for hiatal hernia can range from lifestyle modifications and medication management to minimally invasive surgical procedures, depending on the size of the hernia, associated symptoms, and overall health. Your doctor will guide you through the various treatment options, their benefits, and potential risks, enabling you to make informed decisions about your healthcare.

In conclusion, a hiatal hernia is a common condition that can cause discomfort and complications. Understanding its definition, causes, symptoms, and diagnostic procedures like esophageal manometry is crucial for proper diagnosis and treatment. By recognizing the signs, seeking medical attention, undergoing comprehensive diagnostic tests, and discussing the results with your doctor, you can take proactive steps towards managing your hiatal hernia and improving your overall health and well-being. Remember, early detection and appropriate treatment play a fundamental role in managing hiatal hernias effectively.

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