Hiatus hernia medical therapy: Difference between revisions

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==Overview==
==Overview==
In most cases, Most of the time 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 the major stimulator,  [[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.   
In most cases, Most of the time 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==
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** H-2-receptor blockers, such as [[cimetidine]], [[famotidine]], [[nizatidine]] or [[ranitidine]].
** H-2-receptor blockers, such as [[cimetidine]], [[famotidine]], [[nizatidine]] or [[ranitidine]].
** [[Proton pump inhibitor]]s ([[PPI]]), such as [[lansoprazole]] and [[omeprazole]].
** [[Proton pump inhibitor]]s ([[PPI]]), such as [[lansoprazole]] and [[omeprazole]].
==Overview==
There is no treatment for [disease name]; the mainstay of therapy is supportive care.
OR
Supportive therapy for [disease name] includes [therapy 1], [therapy 2], and [therapy 3].
OR
The majority of cases of [disease name] are self-limited and require only supportive care.
OR
[Disease name] is a medical emergency and requires prompt treatment.
OR
The mainstay of treatment for [disease name] is [therapy].
OR
 
The optimal therapy for [malignancy name] depends on the stage at diagnosis.
OR
[Therapy] is recommended among all patients who develop [disease name].
OR
Pharmacologic medical therapy is recommended among patients with [disease subclass 1], [disease subclass 2], and [disease subclass 3].
OR
Pharmacologic medical therapies for [disease name] include (either) [therapy 1], [therapy 2], and/or [therapy 3].
OR
Empiric therapy for [disease name] depends on [disease factor 1] and [disease factor 2].
OR
Patients with [disease subclass 1] are treated with [therapy 1], whereas patients with [disease subclass 2] are treated with [therapy 2].
==Medical Therapy==
==Medical Therapy==
*Pharmacologic medical therapy is recommended among patients with [disease subclass 1], [disease subclass 2], and [disease subclass 3].
'''Sliding hiatus hernia''' :
*Pharmacologic medical therapies for [disease name] include (either) [therapy 1], [therapy 2], and/or [therapy 3].
*Pharmacologic medical therapy is recommended among patients with Sliding hiatus hernia  when experince symptoms of ''gastroesophageal reflux disease'' (GERD) like<ref name="TranLowry2006">{{cite journal|last1=Tran|first1=T.|last2=Lowry|first2=A. M.|last3=El-Serag|first3=H. B.|title=Meta-analysis: the efficacy of over-the-counter gastro-oesophageal reflux disease therapies|journal=Alimentary Pharmacology and Therapeutics|volume=0|issue=0|year=2006|pages=061016063002004–???|issn=0269-2813|doi=10.1111/j.1365-2036.2006.03135.x}}</ref>
*Empiric therapy for [disease name] depends on [disease factor 1] and [disease factor 2].
**[[Heart burn]]
*Patients with [disease subclass 1] are treated with [therapy 1], whereas patients with [disease subclass 2] are treated with [therapy 2].
**[[Regurgitation]]
===Disease Name===
**[[Dysphagia]]
** [[Chest pain]] that may look like the [[angina pectoris]] pain
** [[Cough]]
** [[Nausea]]
** [[Odynophagia]]
** [[Hypersalivation]] 
*** '''[[Antacids]]''':
**** 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):'''
**** 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]]:'''
**** 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|Prokinetic medications]]:'''
**** Preferred regimen (1): [[Metoclopramide]] 10 mg q24 PO for 4 to 12 weeks


* '''1 Stage 1 - Name of stage'''
*
** 1.1 '''Specific Organ system involved 1'''
****  
*** 1.1.1 '''Adult'''
**** Preferred regimen (1): [[drug name]] 100 mg PO q12h for 10-21 days '''(Contraindications/specific instructions)''' 
**** Preferred regimen (2): [[drug name]] 500 mg PO q8h for 14-21 days
**** Preferred regimen (3): [[drug name]] 500 mg q12h for 14-21 days
**** Alternative regimen (1): [[drug name]] 500 mg PO q6h for 7–10 days 
**** Alternative regimen (2): [[drug name]] 500 mg PO q12h for 14–21 days
**** Alternative regimen (3): [[drug name]] 500 mg PO q6h for 14–21 days
*** 1.1.2 '''Pediatric'''
**** 1.1.2.1 (Specific population e.g. '''children < 8 years of age''')
***** Preferred regimen (1): [[drug name]] 50 mg/kg PO per day q8h (maximum, 500 mg per dose) 
***** Preferred regimen (2): [[drug name]] 30 mg/kg PO per day in 2 divided doses (maximum, 500 mg per dose)
***** Alternative regimen (1): [[drug name]]10 mg/kg PO q6h (maximum, 500 mg per day)
***** Alternative regimen (2): [[drug name]] 7.5 mg/kg PO q12h (maximum, 500 mg per dose)
***** Alternative regimen (3): [[drug name]] 12.5 mg/kg PO q6h (maximum, 500 mg per dose)
****1.1.2.2 (Specific population e.g. '<nowiki/>'''''children < 8 years of age'''''')
***** Preferred regimen (1): [[drug name]] 4 mg/kg/day PO q12h（maximum, 100 mg per dose）
***** Alternative regimen (1): [[drug name]] 10 mg/kg PO q6h (maximum, 500 mg per day)
***** Alternative regimen (2): [[drug name]] 7.5 mg/kg PO q12h (maximum, 500 mg per dose) 
***** Alternative regimen (3): [[drug name]] 12.5 mg/kg PO q6h (maximum, 500 mg per dose)
** 1.2 '''Specific Organ system involved 2'''
*** 1.2.1 '''Adult'''
**** Preferred regimen (1): [[drug name]] 500 mg PO q8h
*** 1.2.2  '''Pediatric'''
**** Preferred regimen (1): [[drug name]] 50 mg/kg/day PO q8h (maximum, 500 mg per dose)


* 2 '''Stage 2 - Name of stage'''
* 2 '''Stage 2 - Name of stage'''

Revision as of 19:22, 7 February 2018

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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, Most of the time 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

Medical Therapy

Sliding hiatus hernia :

  • 2 Stage 2 - Name of stage
    • 2.1 Specific Organ system involved 1
      Note (1):
      Note (2):
      Note (3):
      • 2.1.1 Adult
        • Parenteral regimen
          • Preferred regimen (1): drug name 2 g IV q24h for 14 (14–21) days
          • Alternative regimen (1): drug name 2 g IV q8h for 14 (14–21) days
          • Alternative regimen (2): drug name 18–24 MU/day IV q4h for 14 (14–21) days
        • Oral regimen
          • Preferred regimen (1): drug name 500 mg PO q8h for 14 (14–21) days
          • Preferred regimen (2): drug name 100 mg PO q12h for 14 (14–21) days
          • Preferred regimen (3): drug name 500 mg PO q12h for 14 (14–21) days
          • Alternative regimen (1): drug name 500 mg PO q6h for 7–10 days
          • Alternative regimen (2): drug name 500 mg PO q12h for 14–21 days
          • Alternative regimen (3):drug name 500 mg PO q6h for 14–21 days
      • 2.1.2 Pediatric
        • Parenteral regimen
          • Preferred regimen (1): drug name 50–75 mg/kg IV q24h for 14 (14–21) days (maximum, 2 g)
          • Alternative regimen (1): drug name 150–200 mg/kg/day IV q6–8h for 14 (14–21) days (maximum, 6 g per day)
          • Alternative regimen (2):  drug name 200,000–400,000 U/kg/day IV q4h for 14 (14–21) days (maximum, 18–24 million U per day) '(Contraindications/specific instructions)'
        • Oral regimen
          • Preferred regimen (1): drug name 50 mg/kg/day PO q8h for 14 (14–21) days (maximum, 500 mg per dose)
          • Preferred regimen (2): drug name (for children aged ≥ 8 years) 4 mg/kg/day PO q12h for 14 (14–21) days (maximum, 100 mg per dose)
          • Preferred regimen (3): drug name 30 mg/kg/day PO q12h for 14 (14–21) days (maximum, 500 mg per dose)
          • Alternative regimen (1): drug name 10 mg/kg PO q6h 7–10 days (maximum, 500 mg per day)
          • Alternative regimen (2): drug name 7.5 mg/kg PO q12h for 14–21 days (maximum, 500 mg per dose)
          • Alternative regimen (3): drug name 12.5 mg/kg PO q6h for 14–21 days (maximum,500 mg per dose)
    • 2.2 'Other Organ system involved 2'
      Note (1):
      Note (2):
      Note (3):
      • 2.2.1 Adult
        • Parenteral regimen
          • Preferred regimen (1): drug name 2 g IV q24h for 14 (14–21) days
          • Alternative regimen (1): drug name 2 g IV q8h for 14 (14–21) days
          • Alternative regimen (2): drug name 18–24 MU/day IV q4h for 14 (14–21) days
        • Oral regimen
          • Preferred regimen (1): drug name 500 mg PO q8h for 14 (14–21) days
          • Preferred regimen (2): drug name 100 mg PO q12h for 14 (14–21) days
          • Preferred regimen (3): drug name 500 mg PO q12h for 14 (14–21) days
          • Alternative regimen (1): drug name 500 mg PO q6h for 7–10 days
          • Alternative regimen (2): drug name 500 mg PO q12h for 14–21 days
          • Alternative regimen (3):drug name 500 mg PO q6h for 14–21 days
      • 2.2.2 Pediatric
        • Parenteral regimen
          • Preferred regimen (1): drug name 50–75 mg/kg IV q24h for 14 (14–21) days (maximum, 2 g)
          • Alternative regimen (1): drug name 150–200 mg/kg/day IV q6–8h for 14 (14–21) days (maximum, 6 g per day)
          • Alternative regimen (2):  drug name 200,000–400,000 U/kg/day IV q4h for 14 (14–21) days (maximum, 18–24 million U per day)
        • Oral regimen
          • Preferred regimen (1): drug name 50 mg/kg/day PO q8h for 14 (14–21) days (maximum, 500 mg per dose)
          • Preferred regimen (2): drug name 4 mg/kg/day PO q12h for 14 (14–21) days (maximum, 100 mg per dose)
          • Preferred regimen (3): drug name 30 mg/kg/day PO q12h for 14 (14–21) days (maximum, 500 mg per dose)
          • Alternative regimen (1): drug name 10 mg/kg PO q6h 7–10 days (maximum, 500 mg per day)
          • Alternative regimen (2): drug name 7.5 mg/kg PO q12h for 14–21 days (maximum, 500 mg per dose)
          • Alternative regimen (3): drug name 12.5 mg/kg PO q6h for 14–21 days (maximum,500 mg per dose)


References

  1. ↑ Tran, T.; Lowry, A. M.; El-Serag, H. B. (2006). "Meta-analysis: the efficacy of over-the-counter gastro-oesophageal reflux disease therapies". Alimentary Pharmacology and Therapeutics. 0 (0): 061016063002004–???. doi:10.1111/j.1365-2036.2006.03135.x. ISSN 0269-2813.
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