Hiatus hernia
From Wikipedia, the free encyclopedia
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| ICD-10 | K44., Q40.1 | |
| ICD-9 | 750.6 | |
| OMIM | 142400 | |
| DiseasesDB | 29116 | |
| eMedicine | med/1012 radio/337 | |
| MeSH | C06.405.293.500.467 | |
A hiatus hernia or hiatal hernia is the protrusion (or herniation) of the upper part of the stomach into the thorax through a tear or weakness in the diaphragm.
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[edit] Symptoms
The symptoms include acid reflux, pains, similar to heartburn, in the chest and upper stomach.
In most patients, hiatus hernias cause no symptoms. Sometimes patients experience heartburn and regurgitation, when stomach acid refluxes back into the esophagus.
[edit] Causes
The following are possible causes or contributing factors for having an hiatal hernia:
- Obesity
- Frequent coughing
- Straining with constipation
- Frequent bending over or heavy lifting
- Heredity
- Smoking
[edit] Diagnosis
The diagnosis of a hiatus hernia is typically made through an upper gastrointestinal barium x-ray or by gastroscopy.
[edit] Types
There are two kinds of Hiatal Hernia:
- The first (95%) is the sliding hiatal hernia, where the gastroesophageal junction moves above the diaphragm together with some of the stomach.
- The second kind is rolling (or paraesophageal) hiatal hernia, when a part of the stomach herniates through the hiatus beside, and without movement of, the gastroesophageal junction.
[edit] Treatment
In most cases, sufferers experience no discomfort and no treatment is required. However, when the hiatal hernia is large, or it is of the paraesophageal type, it it likely to cause obstruction and discomfort. 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.
Where hernia symptoms are severe and chronic acid reflux is involved, surgery is sometimes recommended, as chronic reflux can severely injure the esophagus and even lead to esophageal cancer.
The surgical procedure used is called Nissen fundoplication. In fundoplication, the fundus (upper part) of the stomach is wrapped, or plicated, around the inferior part of the esophagus, preventing herniation of the stomach through the diaphragm and the reflux of gastric acid. The procedure is now commonly performed laparoscopically. With proper patient selection, fundoplication has low complication rates and a quick recovery.<Lange CMDT 2006/>
Complications include gas bloat syndrome, dysphagia (trouble swallowing), dumping syndrome, excessive scarring, and rarely, achalasia. The procedure sometimes fails over time, requiring a second surgery to make repairs
[edit] 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-esophageal reflux disease (GERD). In this way a hiatus hernia is associated with all the potential consequences of GERD- heartburn, esophagitis, Barretts oesophagus and oesophageal cancer. However the risk attributable to the hiatus hernia is difficult to quantify, 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.
Another severe complication, although very rare, is a large herniation that can restrict the inflation of a lung, causing pain, breathing problems.
[edit] Epidemiology
Hiatal hernias affect anywhere from 1 to 20% of the population.[citation needed] 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 (paraesophageal), in which the LES remains stationary but the stomach protrudes above the diaphragm. People of all ages can get this condition, but it is more common in older people.
