DIRECT hiatus hernia creates difficult problems in investigation with distressing regularity. Failure of radiologist, endoscopist, surgeon, and prosector to agree on diagnostic criteria is bad enough, although this matter will be solved, no doubt, by arbitration at some point in the future. A larger problem: how does the clinician make use of the diagnosis, once confidently established, in explaining the patient's symptoms? As in any common and well-publicized anatomic defect, hiatus hernia proves a tempting diagnostic excuse to cover a variety of upper abdominal and anterior chest symptoms. It becomes an overworked catchall for complaints that are not understood.
These are well-known matters. Other facets of hiatus hernia behavior, evident to the observant clinician, need to be talked about more. One is the remarkable fact that, in spite of all the regurgitation and other dysrhythmic gastroesophageal activities that accompany uncomplicated hiatus hernia, pulmonary aspiration problems do not occur. Even nocturnal
Palmer ED. Hiatus HerniaThe Postoperative Stomach and Respiratory Problems. JAMA. 1975;233(1):85. doi:10.1001/jama.1975.03260010087035