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Hiatus Hernia

Prolapse of the stomach through the diaphragmatic oesophagal hiatus due to increase in the sphincter pressure causes a hiatus hernia. The lower oesophageal sphincter is a smooth muscle that is about 2 to 4.5 cm in length. The upper portion of the sphincter is in the diaphragmatic hiatus and the lower portion is located intra-abdominally. Sudden intra-abdominal pressure causes an increase in the pressure of the sphincter. Even as the gastroesophageal junction creates a barrier for prevention of reflux of the contents (which is inclusive of the LES baseline pressure) the reflux barrier is compromised and acid clearance is not accomplished due to malfunction of the LES.

Causes

There are several predisposing factors that contribute to the formation of a hiatus hernia:

  • Obesity – can cause increased intra-abdominal pressure leading to the formation of a hiatus hernia

  • Chronic constipation due to a fibreless diet

  • Abdominal ascites – fluid accumulation

  • Gender – it is a common occurrence in women due to pressures exerted during pregnancy

  • Chronic esophagitis leads to reflux-indicated shortening of the oesophagus

  • Age is a contributing factor to a hiatal hernia due to weakening of muscles and decreased tissue elasticity

  • Acquired hiatal hernias are divided into:

    • Non-traumatic: non-traumatic type includes sliding hernia and paraesophageal hernia

    • Traumatic : forceful external injury to the area can lead to a hiatus hernia

Signs and symptoms

A patient having hiatus hernia presents with:

  • Burning sensation in the chest along with pain

  • Retching

  • Nausea and vomiting

  • Rapid rush of saliva into the mouth otherwise known as waterbrash indicating reflux

Diagnosis

  • Barium upper gastrointestinal series – a barium study provides an accurate diagnosis of the condition. The barium is outpouched at the lower tip of the oesophagus. It also distinguishes between a paraesophageal hernia and a sliding hernia.

  • Chest radiographs – clearly indicates the presence of a hiatus hernia

  • Endoscopy – complications of erosive oesophagitis, ulcers in the hernia, tumour or Barrett’s oeosphagus is detected with endoscopy. Biopsy of the suspicious area is taken with the endoscopy.

  • Oesophageal manometry can also be done.

Treatment and medication

Symptoms of GERD are treated by modifying lifestyle, neutralizing acid production and increasing gastric motility. PPI therapy is done for patients with iron deficiency anaemia caused due to large hiatal hernias. Surgical care is inevitable in hernias.

Dr. Deepak conducts surgical procedures to correct gastroesophageal reflux and simultaneously repair the hernia.

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