Gastro-esophageal reflux and hiatus hernia--endoscopy.

The endoscopic diagnosis of hiatal hernia (sliding type) relies on direct and indirect criteria during the oesophagoscopic or gastroscopic approach. A wide separation between the anatomic and mucosal oesophago-gastric junction, the presence of a so-called Schatzki-ring, a wandering junction with sliding gastric mucosal folds during inspiration and two ringlike structures are important. Whereas radiology seems to be superior to endoscopy in the diagnosis of asymptomatic hiatus hernia, oesophagoscopy may reveal sequelae of reflux like oesophagitis, erosions, ulcers and strictures. Peptic oesophagitis is found in about 10% to cause upper gastrointestinal haemorrhage.