In discussing the causes of the difference in the incidence of infantile hiatal hernia between North America and Europe,1 it interests me that the author gives only slight and indirect mention to what I think is the most important variable–the role of the radiologist. It is he alone who makes the diagnosis, based largely on fluoroscopic findings.

Nothing in radiology is so complex and controversial as is the radiologic diagnosis of hiatal hernia. I have personally observed that European pediatric radiologists are more liberal with this diagnosis, describing small hiatal hernias that most American pediatric radiologists would call chalasia, or within normal limits.

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