Hiatus hernia overview: Difference between revisions
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{{Hiatus hernia}} | {{Hiatus hernia}} | ||
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==Overview== | ==Overview== | ||
A hiatus 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]]. | A hiatus 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]]. | ||
==Historical Perspective== | |||
==Classification== | |||
==Pathophysiology== | |||
==Causes== | |||
==Differentiating Hereditary pancreatitis from Other Diseases== | |||
==Epidemiology and Demographics== | ==Epidemiology and Demographics== | ||
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. | 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. | ||
==Risk Factors== | |||
==Screening== | |||
==Natural History, Complications, and Prognosis== | |||
==Diagnosis== | ==Diagnosis== | ||
===History and Symptoms=== | ===History and Symptoms=== | ||
The symptoms include [[gastroesophageal reflux disease|acid reflux]], and pain, similar to heartburn, in the chest and upper stomach. In most patients, hiatus hernias cause no symptoms. Sometimes patients experience [[heartburn]] and [[regurgitation (digestion)|regurgitation]], when [[stomach acid]] refluxes back into the [[esophagus]]. | The symptoms include [[gastroesophageal reflux disease|acid reflux]], and pain, similar to heartburn, in the chest and upper stomach. In most patients, hiatus hernias cause no symptoms. Sometimes patients experience [[heartburn]] and [[regurgitation (digestion)|regurgitation]], when [[stomach acid]] refluxes back into the [[esophagus]]. | ||
===Physical Examination=== | |||
===Laboratory Findings=== | |||
===Electrocardiogram=== | |||
===Chest X Ray=== | ===Chest X Ray=== | ||
On chest radiographs, a paraesophageal [[hernia]] may appear as a soft-tissue-opacity lesion posterior to the heart near the esophageal hiatus. | On chest radiographs, a paraesophageal [[hernia]] may appear as a soft-tissue-opacity lesion posterior to the heart near the esophageal hiatus. | ||
===Ultrasound=== | |||
===CT=== | ===CT=== | ||
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. | 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. | ||
===MRI=== | |||
===Other Imaging Findings=== | |||
===Other Diagnostic Studies=== | |||
==Treatment== | ==Treatment== | ||
===Medical Therapy=== | ===Medical Therapy=== | ||
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. | 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. | ||
===Surgery=== | ===Surgery=== | ||
Surgery is the mainstay of treatment for patients with a symptoms or complications. Paraesophageal hernias can be repaired transabdominally or transthoracically. [[Laparoscopic surgery|Laparoscopic]] approach is preferred for most patients. A [[Nissen fundoplication|Nissen-fundoplication]] is usually done with the surgery. Overall mortality and morbidity rates associated with laparoscopic paraesophageal hernia repair are low. A fixation of the stomach to the abdominal wall (anterior gastropexy) can be used to reduce the risk of gastric reherniation into the thoracic cavity. Complications include [[pneumonia]], p[[Pulmonary embolism|ulmonary embolism]], [[Congestive heart failure|heart failure]], postoperative leak, and recurrence. | Surgery is the mainstay of treatment for patients with a symptoms or complications. Paraesophageal hernias can be repaired transabdominally or transthoracically. [[Laparoscopic surgery|Laparoscopic]] approach is preferred for most patients. A [[Nissen fundoplication|Nissen-fundoplication]] is usually done with the surgery. Overall mortality and morbidity rates associated with laparoscopic paraesophageal hernia repair are low. A fixation of the stomach to the abdominal wall (anterior gastropexy) can be used to reduce the risk of gastric reherniation into the thoracic cavity. Complications include [[pneumonia]], p[[Pulmonary embolism|ulmonary embolism]], [[Congestive heart failure|heart failure]], postoperative leak, and recurrence. | ||
===Primary Prevention=== | |||
===Secondary Prevention=== | |||
==References== | ==References== | ||
Revision as of 21:33, 7 February 2018
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Risk calculators and risk factors for Hiatus hernia overview |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
A hiatus hernia is the protrusion (or herniation) of the upper part of the stomach into the thorax through a tear or weakness in the diaphragm.
Historical Perspective
Classification
Pathophysiology
Causes
Differentiating Hereditary pancreatitis from Other Diseases
Epidemiology and Demographics
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.
Risk Factors
Screening
Natural History, Complications, and Prognosis
Diagnosis
History and Symptoms
The symptoms include acid reflux, and pain, similar to heartburn, in the chest and upper stomach. In most patients, hiatus hernias cause no symptoms. Sometimes patients experience heartburn and regurgitation, when stomach acid refluxes back into the esophagus.
Physical Examination
Laboratory Findings
Electrocardiogram
Chest X Ray
On chest radiographs, a paraesophageal hernia may appear as a soft-tissue-opacity lesion posterior to the heart near the esophageal hiatus.
Ultrasound
CT
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.
MRI
Other Imaging Findings
Other Diagnostic Studies
Treatment
Medical Therapy
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 reduction techniques may be prescribed, or if overweight, weight loss may be indicated. Medications that lower the lower esophageal sphincter (or LES) pressure should be avoided. Antisecretory drugs like proton pump inhibitors and H2 receptor blockers can be used to reduce acid secretion.
Surgery
Surgery is the mainstay of treatment for patients with a symptoms or complications. Paraesophageal hernias can be repaired transabdominally or transthoracically. Laparoscopic approach is preferred for most patients. A Nissen-fundoplication is usually done with the surgery. Overall mortality and morbidity rates associated with laparoscopic paraesophageal hernia repair are low. A fixation of the stomach to the abdominal wall (anterior gastropexy) can be used to reduce the risk of gastric reherniation into the thoracic cavity. Complications include pneumonia, pulmonary embolism, heart failure, postoperative leak, and recurrence.