Dysphagia and oesophageal dilation in giant hiatus hernia: angulation of the gastro-oesophageal junction or achalasia?


  • Pearl Wong Department of Upper Gastrointestinal Surgery, Concord Repatriation Hospital, Sydney, NSW, Australia
  • Doruk Seyfi Department of Upper Gastrointestinal Surgery, Concord Repatriation Hospital, Sydney, NSW, Australia
  • Karl Herba Department of Gastroenterology, Northern Beaches Hospital, Frenchs Forest, NSW, Australia
  • Gregory Falk Department of Upper Gastrointestinal Surgery, Concord Repatriation Hospital, Sydney, NSW, Australia




Hiatus hernia, Dysphagia, Dysmotility disorders


The co-existence of achalasia and large para oesophageal hernia (PEH) is uncommon. The anatomical disruption of the GOJ mechanism by hiatal herniation may result in chronic angulation and secondary partial oesophageal obstruction. A unique case is described where the diagnostic uncertainty of coexistant achalasia and PEH with angulation causing chronic oesophageal obstruction existed. This case highlights the importance of multimodality workup of oesophageal disorders utilising endoscopy, fluoroscopy and manometry. Accurate identification of physiological abnormalities allowed appropriate design of operative intervention.


Goldenberg SP, Vos C, Burrell M, Traube M. Achalasia and hiatal hernia. Dig Dis Sci. 1992;37(4):528-31.

Kotidis KN, Rogers ML, Knowles KR, Beggs FD. Coexisting achalasia and paraoesophageal hiatal hernia. Eur J Cardiothorac Surg. 2002;21(1):130-2.

Sadowski DC, Ackah F, Jiang B, Svenson LW. Achalasia: incidence, prevalence and survival. A population-based study. Neurogastroenterol Motil. 2010;22(9):e256-61.

Roman S, Kahrilas PJ, Kia L, Luger D, Soper N, Pandolfino JE. Effects of large hiatal hernias on esophageal peristalsis. Arch Surg. 2012;147(4):352-7.

Khan AA, Shah SW, Khan MA, Alam A, Butt AK, Shafqat F. Hiatal hernia in achalasia. J Pak Med Assoc. 1998;48(7):196-7.

Palmer ED. Hiatus hernia associated with achalasia of the esophagus. Gastrointest Endosc. 1971;17(4):177-8.

Ushimaru Y, Nakajima K, Takahashi T, Yamasaki M, Mori M, Doki Y. Occult Hiatal Hernia in Achalasia Patients: Its Incidence and Treatment Options. Dig Surg. 2019;36(5):418-25.

Kahrilas PJ, Kim HC, Pandolfino JE. Approaches to the diagnosis and grading of hiatal hernia. Best Pract Res Clin Gastroenterol. 2008;22(4):601-16.

Suter M, Dorta G, Giusti V, Calmes JM. Gastric banding interferes with esophageal motility and gastroesophageal reflux. Arch Surg. 2005;140(7):639-43.

Leslie P, Carding PN, Wilson JA. Investigation and management of chronic dysphagia. BMJ. 2003;326(7386):433-6.

Johnston BT. Oesophageal dysphagia: a stepwise approach to diagnosis and management. Lancet Gastroenterol Hepatol. 2017;2(8):604-9.

Vaezi MF, Pandolfino JE, Yadlapati RH, Greer KB, Kavitt RT. ACG Clinical Guidelines: Diagnosis and Management of Achalasia. Am J Gastroenterol. 2020;115(9):1393-411.

Costantini M, Salvador R, Costantini A. Esophageal Achalasia: Pros and Cons of the Treatment Options. World J Surg. 2022;46(7):1554-60.

Repici A, Fuccio L, Maselli R, Mazza F, Correale L, Mandolesi D, et al. GERD after per-oral endoscopic myotomy as compared with Heller's myotomy with fundoplication: a systematic review with meta-analysis. Gastrointest Endosc. 2018;87(4):934-43.

Gutierrez JH, Aranzana A, Jimenez BM, Corral JSM, Toledo CH. Giant Hiatal Hernia associated to achalasia, a lot of danger! SAGE 2017 Annual Meeting. Houston, Texas. 2017.






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