Hiatus hernia
From Freepedia
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.
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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
A hiatus hernia per se does not cause any symptoms. The condition promotes reflux of gastric contents (via its direct and indirect actions on the anti-reflux mechanism) and thus is associated with gastro-oesophageal reflux disease (GORD). In this way a hiatus hernia is associated with all the potential consequences of GORD- heartburn, oesophagitis, Barretts oesophagus and oesophageal cancer. However the risk attributable to the hiatus hernia is difficult to quantitate, and at most is low. 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.
