Hiatus hernia - Wikipedia, the free encyclopedia

7/10/15, 18:55

Hiatus hernia
From Wikipedia, the free encyclopedia

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. Hiatus hernias often
result in heartburn but may also
cause chest pain or pain with

Ventricular hernia

eating.[1]
The most common cause is obesity.
The diagnosis is often by endoscopy
or medical imaging.[1]
A hiatus hernia may be treated with
lifestyle changes such as raising the
head of the bed, weight loss, and
adjusting eating habits. Medications
such as H2 blockers or proton pump
inhibitors may help. If the symptoms
do not improve with medications the
surgery known as laparoscopic
fundoplication may be an option.[1] It
is not known how commonly hiatus
hernias occur with estimates in North

Classification and external resources

Specialty

DiseasesDB = 29116
ICD-10

K44
(http://apps.who.int/classifications/icd10/browse/2015/en#/K44),
Q40.1
(http://apps.who.int/classifications/icd10/browse/2015/en#/Q40.1)

ICD-9-CM

553.3 (http://www.icd9data.com/getICD9Code.ashx?icd9=553.3),
750.6 (http://www.icd9data.com/getICD9Code.ashx?icd9=750.6)

OMIM

142400 (http://omim.org/entry/142400)

America varying from 10 to 80%.[1]

Contents
1 Signs and symptoms
2 Risk factors
3 Diagnosis
3.1 Classification
4 Treatment
5 Epidemiology
6 References
7 External links

Gastroenterology, general surgery

MedlinePlus 001137
(http://www.nlm.nih.gov/medlineplus/ency/article/001137.htm)
eMedicine

med/1012 (http://www.emedicine.com/med/topic1012.htm)
radio/337 (http://www.emedicine.com/radio/topic337.htm#)

MeSH

D006551 (https://www.nlm.nih.gov/cgi/mesh/2015/MB_cgi?
field=uid&term=D006551)

Signs and symptoms

https://en.wikipedia.org/wiki/Hiatus_hernia

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Hiatal hernia has often been called the "great mimic" because its symptoms can resemble many disorders. For
example, a person with this problem can experience dull pains in the chest, shortness of breath (caused by the
hernia's effect on the diaphragm), heart palpitations (due to irritation of the vagus nerve), and swallowed food
"balling up" and causing discomfort in lower esophagus until it passes on to stomach.
In most cases however, a hiatal hernia does not cause any symptoms. The pain and discomfort that a patient
experiences is due to the reflux of gastric acid, air, or bile. While there are several causes of acid reflux, it does
happen more frequently in the presence of hiatal hernia.
For newborn the presence of Bochdalek hernia can be recognised [2] from symptoms such as difficulty breathing
[3]

fast respiration, increased heart rate.[4]

Risk factors
The following are risk factors that can result in a hiatus hernia.
Increased pressure within the abdomen caused by:
Heavy lifting or bending over
Frequent or hard coughing
Hard sneezing
Violent vomiting
Straining
Stress

Diagnosis
The diagnosis of a hiatus hernia is typically made through an upper GI series, endoscopy or high resolution
manometry.

A large hiatus hernia on Upper GI endoscopy

X-ray marked by open
depicting hiatus hernia
arrows in contrast to the
heart borders marked by
closed arrows

A hiatus hernia as seen

on CT

Classification
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Three types of esophageal hiatal hernia are identified:

type I (sliding) hernia: characterized by an upward herniation of the
cardia and GE junction in the posterior mediastinum. The most common
type of Hiatal hernias (C).[5]
type II (rolling or paraesophageal) hernia (PEH): characterized by an
upward herniation of the gastric fundus alongside a normally positioned
cardia. The GE junction is in its normal place (D).
type III (combined sliding-rolling or mixed) hernia: characterized by
an upward herniation of both the cardia and the gastric fundus.
type IV hiatal hernia: is declared in some taxonomies, when an
additional organ, usually the colon, herniates as well.
The end stage of type I and type II hernias occurs when the whole
stomach migrates up into the chest by rotating 180 around its
longitudinal axis, with the cardia and pylorus as fixed points. In this
situation the abnormality is usually referred to as an intrathoracic
stomach.

Treatment

Schematic diagram of different types

of hiatus hernia. Green is the
esophagus, red is the stomach, purple
is the diaphragm, blue is the HISangle. A is the normal anatomy, B is a
pre-stage, C is a sliding hiatal hernia,
and D is a paraesophageal (rolling)
type.

In most cases, sufferers experience no discomfort and no treatment is

required. If there is pain or discomfort, 3 or 4 sips of room temperature water will usually relieve the pain.
However, when the hiatal hernia is large, or is of the paraesophageal type, it is likely to cause esophageal
stricture and discomfort. Symptomatic patients should elevate the head of their beds and avoid lying down
directly after meals. If the condition has been brought on by stress, stress reduction techniques may be
prescribed, or if overweight, weight loss may be indicated. Medications that reduce the lower esophageal
sphincter (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 gastric fundus (upper part) of
the stomach is wrapped, or plicated, around the inferior part of the esophagus, preventing herniation of the
stomach through the hiatus in the diaphragm and the reflux of gastric acid. The procedure is now commonly
performed laparoscopically. With proper patient selection, laparoscopic fundoplication recent studies have
indicated low complication rates, quick recovery, and relatively good long term results.[6][7][8][9][10]
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.

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Epidemiology
Incidence of hiatal hernias increases with age; approximately 60% of individuals aged 50 or older have a hiatal
hernia.[11] Of these, 9% are symptomatic, depending on the competence of the lower esophageal sphincter
(LES). 95% of these are "sliding" hiatus hernias, in which the 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.
According to Dr. Denis Burkitt, "Hiatus hernia has its maximum prevalence in economically developed
communities in North America and Western Europe ... In contrast the disease is rare in situations typified by
rural African communities."[12] Burkitt attributes the disease to insufficient dietary fiber and the use of the
unnatural sitting position for defecation. Both factors create the need for straining at stool, increasing
intraabdominal pressure and pushing the stomach through the esophageal hiatus in the diaphragm.[13]

References
1. Roman, S; Kahrilas, PJ (23 October 2014). "The diagnosis and management of hiatus hernia.". BMJ (Clinical research
ed.) 349: g6154. doi:10.1136/bmj.g6154 (https://dx.doi.org/10.1136%2Fbmj.g6154). PMID 25341679
(https://www.ncbi.nlm.nih.gov/pubmed/25341679).
2. doi: 10.1016/s1875-9572(10)60006-x
3. doi: :10.1016/j.athoracsur.2013
4. doi:10.1016/s0377-1237(05)80177-7
5. Brunicardi, F. Charles; Dane K. Andersen; Timothy R. Billiar (2010). "Chapter 25: Esophagus and Diaphragmatic
Hernia". Schwartz's Principles of Surgery (9th ed.). New York: McGraw-Hill, Medical Pub. Division. pp. 842843.
ISBN 978-0-07-1547703.
6. Migaczewski M et al. (January 2013). "Laparoscopic Nissen fundoplication in the treatment of Barrett's esophagus"
(http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3699774/). NCBI (PMC3699774). doi:10.5114/wiitm.2011.32941
(https://dx.doi.org/10.5114%2Fwiitm.2011.32941).
7. Testoni PA et al. (May 2012). "Transoral incisionless fundoplication for treatment of gastroesophageal reflux disease in
clinical practice" (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3472060/). NCBI (PMC3472060).
doi:10.1007/s00464-012-2324-2 (https://dx.doi.org/10.1007%2Fs00464-012-2324-2).
8. Ozmen V et al. (Dec 2005). "Histologic and clinical outcome after laparoscopic Nissen fundoplication for
gastroesophageal reflux disease and Barrett's esophagus" (http://www.ncbi.nlm.nih.gov/pubmed/16362470). NCBI.
PMID 16362470 (https://www.ncbi.nlm.nih.gov/pubmed/16362470).
9. Abbas AE et al. (Feb 2004). "Barrett's esophagus: the role of laparoscopic fundoplication"
(http://www.ncbi.nlm.nih.gov/pubmed/14759403). NCBI. PMID 14759403
(https://www.ncbi.nlm.nih.gov/pubmed/14759403).
10. "Journal Index PDF (fee for article)" (http://bu.edu.eg/portal/uploads/discussed_thesis/11311862/11311862_R.pdf) (PDF).
Lange Current Medical Diagnosis & Treatment 2006.
11. Goyal Raj K, "Chapter 286. Diseases of the Esophagus". Harrison's Principles of Internal Medicine, 17e.
12. Burkitt DP (1981). "Hiatus hernia: is it preventable?" (http://www.ajcn.org/cgi/reprint/34/3/428.pdf) (PDF). Am. J. Clin.
Nutr. 34 (3): 42831. PMID 6259926 (https://www.ncbi.nlm.nih.gov/pubmed/6259926).
13. Sontag S (1999). "Defining GERD" (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2579007). Yale J Biol Med 72 (23): 6980. PMC 2579007 (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2579007). PMID 10780568
(https://www.ncbi.nlm.nih.gov/pubmed/10780568).

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External links
01011 (http://chorus.rad.mcw.edu/doc/01011.html) at CHORUS
Hiatal hernia CT Scans (http://www.ctcases.net/ct-cases-

Wikimedia Commons has

media related to Hiatal
hernia.

database/4%20Abdomen%20And%20Pelvis/5%20Gastrointestinal%20Tract/4.5.13%20Hiatal%20hernia/
) - CT Cases
Hiatus Hernia - Help and Advice (http://www.teammead.co.uk/hiatushernia) - Hiatus Hernia - Help and
Advice
Retrieved from "https://en.wikipedia.org/w/index.php?title=Hiatus_hernia&oldid=669843545"
Categories: Diaphragmatic hernias Congenital disorders of digestive system
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