A hiatus hernia occurs when abdominal contents protrude through an enlarged oesophageal hiatus in the diaphragm.
What are the main types of hiatus hernias?
- Sliding hiatal hernia (80%): The gastro-oesophageal junction slides up into the chest. A less competent sphincter results in acid reflux. Treatment is similar as for GORD.
- Rolling hiatal hernia (20%): The gastro-oesophageal junction remains in the abdomen but part of the stomach protrude into the chest alongside the oesophagus. This type needs more urgent treatment as volvulus can result in ischemia and necrosis.
Risk factors
- Obesity
- Previous hiatal surgery
- Increased intra-abdominal pressure (such as chronic cough, multiparity or ascites)
PC
Symptoms include heartburn, dysphagia, regurgitation, odynophagia, shortness of breath, chronic cough and chest pain.
Investigations
- barium swallows (upper GI series), which is the most sensitive method
- endoscopy and oesophageal manometry.
Management
Conservative
Conservative management includes crucial lifestyle changes. Lifestyle advice for patients with hiatal hernia includes: