Hiatal hernia

• Hiatal hernia: herniation of a portion of the stomach into esophagus through an opening in th diaphragm
• Cause is unknown but contributing factors are:

  • weakening of muscle in diaphragm around esophagogastric opening
  • increased abdominal pressure (eg: obesity)
  • age
  • poor nutrition
• Clinical manifestations are similar to GERD, gallbldder disease, peptic ulcer disease and angina
• Most common symptoms are heartburn, especially after meals or in a supine position and dysphagia
• Complications:

  • GERD
  • hemorrhage from erosion
  • stenosis
  • ulceration of herniated portion
  • strangulation of hernia
  • regurgitation with aspiration
• Diagnostic studies

  • barium swallow: reveal protrusion of gastric mucosa through the esophageal hiatus
  • gastroscopy: visualization of lower esophagus and inflammation extent
• Management

  • conservative therapy: lifestyle modification, meds, weight loss
  • surgical therapy: anchoring lower esophageal sphincter by wrapping a portion of stomach around it to anchor it in place