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| ==Overview==
| | {{SK}} Hiatal hernia |
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| A '''hiatus hernia''' or '''[[hiatal hernia]]''' is the protrusion (or [[Hernia|herniation]]) of the upper part of the [[stomach]] into the [[thorax]] through a tear or weakness in the [[diaphragm (anatomy)|diaphragm]].
| | ==[[Hiatus hernia overview|Overview]]== |
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| ==Symptoms== | | ==[[Hiatus hernia historical perspective|Historical Perspective]]== |
| The symptoms include [[Gastroesophageal reflux disease|acid reflux]], and pain, similar to heartburn, in the chest and upper stomach.
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| In most patients, hiatus hernias cause no symptoms. Sometimes patients experience [[heartburn]] and [[Regurgitation (digestion)|regurgitation]], when [[stomach acid]] refluxes back into the [[esophagus]].
| | ==[[Hiatus hernia classification|Classification]]== |
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| ==Causes== | | ==[[Hiatus hernia pathophysiology|Pathophysiology]]== |
| The following are possible causes or contributing factors for having a hiatus hernia:
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| * [[Obesity]]
| | ==[[Hiatus hernia causes|Causes]]== |
| * Frequent [[coughing]]
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| * Straining with [[constipation]]
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| * Frequent bending over or heavy lifting
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| * [[Heredity]]
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| * [[tobacco smoking|Smoking]]
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| * [[Stress (medicine)|Stress]]
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| ==Diagnosis== | | ==[[Hiatus hernia differential diagnosis|Differentiating Hiatus hernia from other Diseases]]== |
| [[Image:Hiatus-hernia.jpg|thumb|180px|left|[[gastroscopy|Upper GI endoscopy]] depicting hiatus hernia.]] | |
| The diagnosis of a hiatus hernia is typically made through an [[upper GI series]] or [[gastroscopy|endoscopy]].
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| The imaging findings are
| | ==[[Hiatus hernia epidemiology and demographics|Epidemiology and Demographics]]== |
| * On chest radiographs, a paraesophageal hernia may appear as a soft-tissue-opacity lesion posterior to the heart near the esophageal hiatus.
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| * CT helps verify migration of the stomach cranially through the hiatus. Sagittal and coronal reformatted images often help demonstrate the hernia and the hiatal defect.
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| '''Patient #1: Sliding hiatal hernia'''
| | ==[[Hiatus hernia risk factors|Risk Factors]]== |
| <gallery>
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| Image:
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| Hiatal-hernia-001.jpg
| | ==[[Hiatus hernia screening|Screening]]== |
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| | ==[[Hiatus hernia natural history, complications and prognosis|Natural History, Complications and Prognosis]]== |
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| Hiatal-hernia-002.jpg
| | ==Diagnosis== |
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| Hiatal-hernia-003.jpg
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| Hiatal-hernia-004.jpg
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| </gallery>
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| '''Patient #2: Sliding hiatal hernia'''
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| <gallery>
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| Large-hiatal-hernia-001.jpg
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| Large-hiatal-hernia-002.jpg
| | [[Hiatus hernia diagnostic criteria|Diagnostic Criteria]] | [[Hiatus hernia history and symptoms|History and Symptoms]] | [[Hiatus hernia physical examination|Physical Examination]] | [[Hiatus hernia laboratory findings|Laboratory Findings]] | [[Hiatus hernia electrocardiogram|EKG]] | [[Hiatus hernia CT|CT]] | [[Hiatus hernia MRI|MRI]] | [[Hiatus hernia echocardiography or ultrasound|Echocardiography or Ultrasound]] | [[Hiatus hernia other imaging findings|Other Imaging Findings]] | [[Hiatus hernia other diagnostic studies|Other Diagnostic Studies]] |
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| </gallery>
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| '''Patient #3: Paraesophageal hernia'''
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| Paraesophageal-hernia-001.jpg
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| Paraesophageal-hernia-002.jpg
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| </gallery>
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| ==Types==
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| There are two major kinds of hiatus hernia:
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| * The most common (95%) is the sliding hiatus hernia, where the [[gastroesophageal junction]] moves above the diaphragm together with some of the stomach.
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| * The second kind is rolling (or paraesophageal) hiatus hernia, when a part of the stomach herniates through the [[esophageal hiatus]] beside, and without movement of, the gastroesophageal junction. It is about 100 times less common than the first kind. <ref name="Lawrence">{{cite book| author=Lawrence, P. | title=Essentials of General Surgery| location= Baltimore | publisher= Williams & Wilkins | year = 1992 | page = 178 | ISBN = 0-683-04869-4}}</ref>
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| A third kind is also sometimes described, and is a combination of the first and second kinds.
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| ==Treatment== | | ==Treatment== |
| In most cases, sufferers experience no discomfort and no treatment is required. 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 until treatment is rendered. If the condition has been brought on by stress, [[stress management|stress reduction techniques]] may be prescribed, or if overweight, [[weight loss]] may be indicated. Medications that lower the [[lower esophageal sphincter]] (or [[Lower esophageal sphincter|LES]]) pressure should be avoided. Antisecretory drugs like [[proton pump inhibitors]] and [[Histamine H2 receptor|H2 receptor]] blockers can be used to reduce acid secretion.
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| 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]].
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| The surgical procedure used is called [[Nissen fundoplication]]. In fundoplication, the [[Fundus (stomach)|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 [[Laparoscopic surgery|laparoscopically]]. With proper patient selection, laparoscopic fundoplication has low complication rates and a quick recovery.<ref name="Lange">Lange CMDT 2006</ref>
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| Complications include [[Nissen fundoplication|gas bloat syndrome]], [[dysphagia]] (trouble swallowing), [[Gastric dumping syndrome|dumping syndrome]], excessive scarring, and rarely, [[achalasia]]. The procedure sometimes fails over time, requiring a second surgery to make repairs.
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| ==Complications==
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| 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 [[gastroesophageal reflux disease]] (GERD). In this way a hiatus hernia is associated with all the potential consequences of GERD - [[heartburn]], [[esophagitis]], [[Barrett's esophagus]] and [[esophageal cancer]]. However the risk attributable to the hiatus hernia is difficult to quantify, and at most is low.
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| Besides discomfort from GERD 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 [[strangulating|strangulate]] a portion of the stomach above the diaphragm. This strangulation can result in esophageal or GI tract obstruction and the tissue even become [[ischemic]] and [[necrosis|necrose]].
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| Another severe complication, although very rare, is a large herniation that can restrict the inflation of a [[lung]], causing pain and breathing problems.
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| ==Epidemiology==
| | [[Hiatus hernia medical therapy|Medical Therapy]] | [[Hiatus hernia surgery|Surgery]] | [[Hiatus hernia primary prevention|Primary Prevention]] | [[Hiatus hernia secondary prevention|Secondary Prevention]] | [[Hiatus hernia cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Hiatus hernia future or investigational therapies|Future or Investigational Therapies]] |
| Hiatus hernias affect anywhere from 1 to 20% of the population. 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. | |
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| ==Notes and references== | | ==Case Studies== |
| <div class="references">
| | [[Hiatus hernia case study one|Case #1]] |
| <references/>
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| </div>
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| ==External links== | | ==External links== |
