Hiatus hernia medical therapy

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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

Lifestyle Modifications

Paraesophageal hernia 

  • Pharmacologic medical therapies for Paraesophageal hernia asymptomatic patients remain always  controversial.[9]

References

  1. 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.
  2. 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.
  3. Ness-Jensen E, Hveem K, El-Serag H, Lagergren J (2016). "Lifestyle Intervention in Gastroesophageal Reflux Disease". Clin Gastroenterol Hepatol. 14 (2): 175-82.e1-3. doi:10.1016/j.cgh.2015.04.176. PMC 4636482. PMID 25956834.
  4. Khoury RM, Camacho-Lobato L, Katz PO, Mohiuddin MA, Castell DO. Influence of spontaneous sleep positions on nighttime recumbent reflux in patients with gastroesophageal reflux disease. Am J Gastroenterol 1999;94:2069-73. PMID 10445529.
  5. 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.
  6. 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.
  7. 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.
  8. 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.
  9. 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.