Hiatus hernia

From Academic Kids

Hiatus hernia or hiatal hernia is the protrusion (or hernia) of the upper part of the stomach into the thorax through a tear or weakness in the diaphragm.

The symptoms include pains, similar to heartburn, in the chest and upper stomach. Surgery is recommended, although it can have minor side-effects such as increased production of stomach and intestinal gas.

Contents

Causes

The following are possible causes or contributing factors for having an hiatal hernia:

  • Obesity
  • Poor seated posture (such as slouching)
  • Frequent coughing
  • Straining with constipation
  • Frequent bending over or heavy lifting
  • Heredity
  • Smoking
  • Congenital defects

Epidemiology

Hiatal hernias affect anywhere from 1 to 20% of the population. Of these, 9% are symptomatic, depending on the competence of the lower esophageal sphincter. 95% of these are "sliding" hiatal hernias, in which the lower esophageal sphincter (LES) protrudes above the diaphragm along with the stomach, and only 5% are the "rolling" type, in which the LES remains stationary but the stomach protrudes above the diaphragm.

Complications

Besides discomfort from reflux and dysphagia, hiatal hernias can have severe consequences for patients if not treated. While sliding hernias are primarily associated with gastroesophageal acid reflux, rolling hernias can strangulate a portion of the stomach above the diaphragm. This strangulation can result in esophageal or GI tract obstruction and even become ischemic and necrose.

Treatment

Symptomatic patients should be told to elevate the head of their beds and avoid lying down directly after meals. If overweight, weight loss is indicated. Medications that lower the LES pressure should be avoided. Antisecretory drugs like proton pump inhibitors and H2-receptor blockers can be used to reduce acid secretion. Endoscopic plication or radiofrequency energy delivery to the LES may be considered. Surgery should be considered if these modalities don't work. Surgery usually consists of Nissen fundoplication, which usually is successful in eradicating symptoms.

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