The Development and Natural History of Hiatal Hernias: A Study Using Sequential Barium Upper Gastrointestinal Series

Ann Surg. 2022 Mar 1;275(3):534-538. doi: 10.1097/SLA.0000000000004140.


Objective: The aim of this study was to use barium upper gastrointestinal series (UGI) to evaluate the development and natural history of a hiatal hernia.

Summary of background data: Hiatal hernias are common but the natural history of sliding and paraesophageal type hernias is poorly understood.

Methods: We reviewed UGI reports from 1987 to 2017 using a word scanning software program to identify individuals that had a hiatal hernia. Only those with at least 2 UGI studies 5 or more years apart were selected. The studies were then reviewed.

Results: There were 89 individuals that met inclusion criteria. Twenty-one people had no hiatal hernia on initial UGI and over a median of 99 months a sliding hiatal hernia (SHH) developed in 16 and a PEH developed in 5 people. A SHH was present on initial UGI in 55 people and at a median of 84 months subsequent UGI showed the SHH was stable in 11 (20%), increased in size in 30 (55%), and changed to a PEH in 14 people (25%). In 13 people a PEH was present on initial UGI and over a median of 97 months it was stable in 5 and increased in size in 8 people (62%).

Conclusions: We showed that both SHH and PEH can develop over time and that the majority of both increased in size on follow-up UGI study. Further, 25% of SHH became a PEH over time. Recognizing an increase in size or change in type of a hiatal hernia may be clinically relevant to help understand changing or worsening symptoms in an individual.

MeSH terms

  • Barium
  • Female
  • Hernia, Hiatal / diagnostic imaging*
  • Humans
  • Male
  • Middle Aged
  • Upper Gastrointestinal Tract / diagnostic imaging*


  • Barium