Hiatus hernia medical therapy: Difference between revisions
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==Overview== | ==Overview== | ||
In most cases, | In most cases, patients experience no discomfort and no treatment is required. However, when a hiatal hernia is large, it is likely to cause [[esophageal stricture]] which results in discomfort. Symptomatic patients benefit from not lying down immediately after meals and also benefit by elevating the head of their beds. If stress has been idetified as the major riskfactor, [[stress management|stress reduction techniques]] may be practiced, or if overweight, [[weight loss]] may be indicated. Certain medications causes [[lower esophageal sphincter]] (or [[Lower esophageal sphincter|LES]] to relax those medications should be avoided. Anti-acid drugs like [[proton pump inhibitors]] and [[Histamine H2 receptor|H2 receptor]] blockers can be used to decrease the acid secretion. | ||
==Medical Therapy== | ==Medical Therapy== | ||
'''Sliding hiatus hernia''' | |||
Pharmacologic medical therapy is recommended among the patients with '''Sliding [[hiatus hernia]]''' when experince symptoms of gastroesophageal reflux disease (GERD) symptoms like:<ref name="pmid21927653">{{cite journal| author=Hyun JJ, Bak YT| title=Clinical significance of hiatal hernia. | journal=Gut Liver | year= 2011 | volume= 5 | issue= 3 | pages= 267-77 | pmid=21927653 | doi=10.5009/gnl.2011.5.3.267 | pmc=3166665 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21927653 }} </ref> | |||
* [[Nausea]] | |||
* [[Vomiting]] | |||
* [[Regurgitation]] | |||
* [[Heart burn]] | |||
* [[Regurgitation]] | |||
* [[Dysphagia]] | |||
===Lifestyle Modifications=== | ===Lifestyle Modifications=== | ||
*The following measures are recommended as the first line to treat GERD:<ref name="pmid17573791">{{cite journal |author=Piesman M, Hwang I, Maydonovitch C, Wong RK |title=Nocturnal reflux episodes following the administration of a standardized meal. Does timing matter? |journal=Am. J. Gastroenterol. |volume=102 |issue=10 |pages=2128–34 |year=2007 |pmid=17573791 |doi=10.1111/j.1572-0241.2007.01348.x}}</ref><ref name="pmid16682569">{{cite journal |author=Kaltenbach T, Crockett S, Gerson LB |title=Are lifestyle measures effective in patients with gastroesophageal reflux disease? An evidence-based approach |journal=Arch. Intern. Med. |volume=166 |issue=9 |pages=965–71 |year=2006 |pmid=16682569 |doi=10.1001/archinte.166.9.965}} | *The following measures are recommended as the first line to treat [[GERD]]:<ref name="pmid17573791">{{cite journal |author=Piesman M, Hwang I, Maydonovitch C, Wong RK |title=Nocturnal reflux episodes following the administration of a standardized meal. Does timing matter? |journal=Am. J. Gastroenterol. |volume=102 |issue=10 |pages=2128–34 |year=2007 |pmid=17573791 |doi=10.1111/j.1572-0241.2007.01348.x}}</ref><ref name="pmid16682569">{{cite journal |author=Kaltenbach T, Crockett S, Gerson LB |title=Are lifestyle measures effective in patients with gastroesophageal reflux disease? An evidence-based approach |journal=Arch. Intern. Med. |volume=166 |issue=9 |pages=965–71 |year=2006 |pmid=16682569 |doi=10.1001/archinte.166.9.965}}</ref> | ||
**[[Weight loss]] | **[[Weight loss]] | ||
**Elevating head of the bed | **Elevating head of the bed | ||
**No eating two hours before going sleep | **No eating two hours before going sleep | ||
*Avoidance of the following foods and lifestyles is recommended in treatment of GERD: | *Avoidance of the following foods and lifestyles is recommended in treatment of [[GERD]]: | ||
**[[Coffee]] | **[[Coffee]] | ||
**[[Alcohol]] | **[[Alcohol]] | ||
| Line 23: | Line 33: | ||
**[[Cruciferous vegetables]] such as: Onions, cabbage, cauliflower, broccoli, spinach, brussel sprouts | **[[Cruciferous vegetables]] such as: Onions, cabbage, cauliflower, broccoli, spinach, brussel sprouts | ||
**[[Milk]] and milk-based products | **[[Milk]] and milk-based products | ||
**Medical therapy<ref name="pmid21927653">{{cite journal |vauthors=Hyun JJ, Bak YT |title=Clinical significance of hiatal hernia |journal=Gut Liver |volume=5 |issue=3 |pages=267–77 |date=September 2011 |pmid=21927653 |pmc=3166665 |doi=10.5009/gnl.2011.5.3.267 |url=}}</ref><ref name="pmid21960816">{{cite journal |vauthors=Pandolfino JE |title=Hiatal hernia and the treatment of Acid-related disorders |journal=Gastroenterol Hepatol (N Y) |volume=3 |issue=2 |pages=92–4 |date=February 2007 |pmid=21960816 |pmc=3099358 |doi= |url=}}</ref> | |||
* | *** '''[[Antacids]]''':<ref name="pmid1977703">{{cite journal |vauthors=Sontag SJ |title=The medical management of reflux esophagitis. Role of antacids and acid inhibition |journal=Gastroenterol. Clin. North Am. |volume=19 |issue=3 |pages=683–712 |year=1990 |pmid=1977703 |doi= |url=}}</ref><ref name="pmid219608162">{{cite journal |vauthors=Pandolfino JE |title=Hiatal hernia and the treatment of Acid-related disorders |journal=Gastroenterol Hepatol (N Y) |volume=3 |issue=2 |pages=92–4 |date=February 2007 |pmid=21960816 |pmc=3099358 |doi= |url=}}</ref> | ||
*** '''[[Antacids]]''': | |||
**** Preferred regimen (1): [[Aluminum hydroxide]] 640 mg 5 to 6 times daily PO after meals and at bed time. | **** Preferred regimen (1): [[Aluminum hydroxide]] 640 mg 5 to 6 times daily PO after meals and at bed time. | ||
**** Preferred regimen (2): [[Calcium carbonate]] One gram PO. | **** Preferred regimen (2): [[Calcium carbonate]] One gram PO. | ||
*** '''Histamine-receptor antagonists (H2RA):''' | *** '''[[Histamine-2 receptor blocker|Histamine-receptor antagonists]] (H2RA):'''<ref name="pmid12753150">{{cite journal |vauthors=Komazawa Y, Adachi K, Mihara T, Ono M, Kawamura A, Fujishiro H, Kinoshita Y |title=Tolerance to famotidine and ranitidine treatment after 14 days of administration in healthy subjects without Helicobacter pylori infection |journal=J. Gastroenterol. Hepatol. |volume=18 |issue=6 |pages=678–82 |year=2003 |pmid=12753150 |doi= |url=}}</ref> | ||
**** Preferred regimen (1): [[Ranitidine]] 150 mg q12 daily PO | **** Preferred regimen (1): [[Ranitidine]] 150 mg q12 daily PO | ||
**** Preferred regimen (2): [[Cimetidine]] 400 mg q6h or 800 mg q12 PO for 12 weeks | **** Preferred regimen (2): [[Cimetidine]] 400 mg q6h or 800 mg q12 PO for 12 weeks | ||
| Line 45: | Line 46: | ||
*** '''[[Prokinetic|Prokinetic medications]]:''' | *** '''[[Prokinetic|Prokinetic medications]]:''' | ||
**** Preferred regimen (1): [[Metoclopramide]] 10 mg q24 PO for 4 to 12 weeks | **** Preferred regimen (1): [[Metoclopramide]] 10 mg q24 PO for 4 to 12 weeks | ||
'''Paraesophageal hernia''' | |||
* Pharmacologic medical therapies for Paraesophageal hernia [[asymptomatic]] patients remain always controversial.<ref name="pmid18790148">{{cite journal |vauthors=Davis SS |title=Current controversies in paraesophageal hernia repair |journal=Surg. Clin. North Am. |volume=88 |issue=5 |pages=959–78, vi |year=2008 |pmid=18790148 |doi=10.1016/j.suc.2008.05.005 |url=}}</ref> | |||
==References== | ==References== | ||
{{Reflist|2}} | {{Reflist|2}} | ||
[[Category:Surgery]] | |||
[[Category:Gastroenterology]] | |||
[[Category:Up-To-Date]] | |||
[[Category:Disease]] | [[Category:Disease]] | ||
Latest revision as of 22:10, 29 July 2020
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Vamsikrishna Gunnam M.B.B.S [2]
Overview
In most cases, patients experience no discomfort and no treatment is required. However, when a hiatal hernia is large, it is likely to cause esophageal stricture which results in discomfort. Symptomatic patients benefit from not lying down immediately after meals and also benefit by elevating the head of their beds. If stress has been idetified as the major riskfactor, stress reduction techniques may be practiced, or if overweight, weight loss may be indicated. Certain medications causes lower esophageal sphincter (or LES to relax those medications should be avoided. Anti-acid drugs like proton pump inhibitors and H2 receptor blockers can be used to decrease the acid secretion.
Medical Therapy
Sliding hiatus hernia
Pharmacologic medical therapy is recommended among the patients with Sliding hiatus hernia when experince symptoms of gastroesophageal reflux disease (GERD) symptoms like:[1]
Lifestyle Modifications
- The following measures are recommended as the first line to treat GERD:[2][3]
- Weight loss
- Elevating head of the bed
- No eating two hours before going sleep
- Avoidance of the following foods and lifestyles is recommended in treatment of GERD:
- Coffee
- Alcohol
- Excessive amounts of Vitamin C supplements
- Foods high in fats
- Smoking
- Eating shortly before bedtime
- Large meals
- Chocolate and peppermint.
- Acidic foods, such as oranges and tomatoes.
- Cruciferous vegetables such as: Onions, cabbage, cauliflower, broccoli, spinach, brussel sprouts
- Milk and milk-based products
- Medical therapy[1][4]
- Antacids:[5][6]
- Preferred regimen (1): Aluminum hydroxide 640 mg 5 to 6 times daily PO after meals and at bed time.
- Preferred regimen (2): Calcium carbonate One gram PO.
- Histamine-receptor antagonists (H2RA):[7]
- Preferred regimen (1): Ranitidine 150 mg q12 daily PO
- Preferred regimen (2): Cimetidine 400 mg q6h or 800 mg q12 PO for 12 weeks
- Preferred regimen (3): Famotidine 20 mg q12 PO for 6 weeks
- Proton pump inhibitors:[8][9]
- Preferred regimen (1): Omeprazole 20 mg q24 PO for up to 4 weeks
- Preferred regimen (2): Esomeprazole 20 mg or 40 mg q24 IV
- Prokinetic medications:
- Preferred regimen (1): Metoclopramide 10 mg q24 PO for 4 to 12 weeks
- Antacids:[5][6]
Paraesophageal hernia
- Pharmacologic medical therapies for Paraesophageal hernia asymptomatic patients remain always controversial.[10]
References
- ↑ 1.0 1.1 Hyun JJ, Bak YT (2011). "Clinical significance of hiatal hernia". Gut Liver. 5 (3): 267–77. doi:10.5009/gnl.2011.5.3.267. PMC 3166665. PMID 21927653.
- ↑ Piesman M, Hwang I, Maydonovitch C, Wong RK (2007). "Nocturnal reflux episodes following the administration of a standardized meal. Does timing matter?". Am. J. Gastroenterol. 102 (10): 2128–34. doi:10.1111/j.1572-0241.2007.01348.x. PMID 17573791.
- ↑ Kaltenbach T, Crockett S, Gerson LB (2006). "Are lifestyle measures effective in patients with gastroesophageal reflux disease? An evidence-based approach". Arch. Intern. Med. 166 (9): 965–71. doi:10.1001/archinte.166.9.965. PMID 16682569.
- ↑ Pandolfino JE (February 2007). "Hiatal hernia and the treatment of Acid-related disorders". Gastroenterol Hepatol (N Y). 3 (2): 92–4. PMC 3099358. PMID 21960816.
- ↑ Sontag SJ (1990). "The medical management of reflux esophagitis. Role of antacids and acid inhibition". Gastroenterol. Clin. North Am. 19 (3): 683–712. PMID 1977703.
- ↑ Pandolfino JE (February 2007). "Hiatal hernia and the treatment of Acid-related disorders". Gastroenterol Hepatol (N Y). 3 (2): 92–4. PMC 3099358. PMID 21960816.
- ↑ Komazawa Y, Adachi K, Mihara T, Ono M, Kawamura A, Fujishiro H, Kinoshita Y (2003). "Tolerance to famotidine and ranitidine treatment after 14 days of administration in healthy subjects without Helicobacter pylori infection". J. Gastroenterol. Hepatol. 18 (6): 678–82. PMID 12753150.
- ↑ Inadomi JM, Jamal R, Murata GH, Hoffman RM, Lavezo LA, Vigil JM, Swanson KM, Sonnenberg A (2001). "Step-down management of gastroesophageal reflux disease". Gastroenterology. 121 (5): 1095–100. PMID 11677201.
- ↑ Inadomi JM, McIntyre L, Bernard L, Fendrick AM (2003). "Step-down from multiple- to single-dose proton pump inhibitors (PPIs): a prospective study of patients with heartburn or acid regurgitation completely relieved with PPIs". Am. J. Gastroenterol. 98 (9): 1940–4. doi:10.1111/j.1572-0241.2003.07665.x. PMID 14499769.
- ↑ Davis SS (2008). "Current controversies in paraesophageal hernia repair". Surg. Clin. North Am. 88 (5): 959–78, vi. doi:10.1016/j.suc.2008.05.005. PMID 18790148.