Hiatus hernia

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Ventricular hernia
Classification and
external resources

K44.,
ICD-10
Q40.1
553.3,
ICD-9
750.6
OMIM 142400
DiseasesDB 29116
MedlinePlus 001137
med/1012
eMedicine
radio/337
MeSH D006551
A hiatus hernia or hiatal hernia is the
protrusion (or herniation) of the upper part
of the stomach into the thorax through a tear
or weakness in the diaphragm.
Contents
[hide]
• 1 Classification

• 2 Signs and symptoms

• 3 Risk factors

• 4 Diagnosis

• 5 Treatment

• 6 Prognosis

• 7 Epidemiology

• 8 Notes and references

• 9 External links

[edit] Classification
Schematic diagram of different types of
hiatus hernia. Green is the esophagus, Red is
the diaphragm, blue is the HIS-angle. A is
the normal anatomy, B is a pre-stage, C is a
sliding hiatal hernia, and D is a
paraesophageal type
There are two major kinds of hiatus hernia:
[1]

• The most common (95%) is the sliding

hiatus hernia, where the
gastroesophageal junction moves above
the diaphragm together with some of the
stomach.
 • The second kind is rolling (or
paraesophageal) hiatus hernia, when a
part of the stomach herniates through the
esophageal hiatus and lies beside the
esophagus, without movement of the
gastroesophageal junction. It accounts
for the remaining 5% of hiatus hernias. [2]
A third kind is also sometimes described,
and is a combination of the first and second
kinds.
[edit] Signs and symptoms
Hiatal Hernia has often been called the
"great mimic" because its symptoms can
resemble many disorders. For example, a
person with this problem can experience dull
pains in his or her chest, shortness of breath
(caused by the hernia's effect on the
diaphragm), and heart palpitations (due to
irritation of the vagus nerve).
In most cases however, a hiatal hernia does
not cause any symptoms. The pain and
discomfort that a patient experiences is due
to the reflux of gastric acid, air or bile.
While there are several causes of acid reflux,
it does happen more frequently in the
presence of hiatal hernia.
[edit] Risk factors
The following are risk factors that can result
in a hiatus hernia.
• Increased pressure within the abdomen

caused by:
○Heavy lifting or bending over
○ Frequent or hard coughing

○Hard sneezing
○ Pregnancy and delivery

○ Violent vomiting

○ Straining with constipation

○ Obesity (extra weight pushes down

on the abdomen increasing the

pressure)
 ○Use of the sitting position for
defecation[3] (See epidemiology
below)
• Heredity

• Smoking

• Drug use, such as cocaine.

[citation needed]

• Stress

• Diaphragm weakness
[citation needed]

[edit] Diagnosis

A large hiatus hernia on Xray marked by

open arrows in contrast to the heart borders
marked by closed arrows.
Upper GI endoscopy depicting hiatus hernia.
The diagnosis of a hiatus hernia is typically
made through an upper GI series, endoscopy
or High resolution manometry.
[edit] Treatment
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 reduce
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.
Where hernia symptoms are severe and
chronic acid reflux is involved, surgery is
sometimes recommended, as chronic reflux
can severely injure the esophagus and even
lead to esophageal cancer.
The surgical procedure used is called Nissen
fundoplication. In fundoplication, the gastric
fundus (upper part) of the stomach is
wrapped, or plicated, around the inferior part
of the esophagus, preventing herniation of
the stomach through the hiatus in the
diaphragm and the reflux of gastric acid.
The procedure is now commonly performed
laparoscopically. With proper patient
selection, laparoscopic fundoplication has
low complication rates and a quick recovery.
[4]

Complications include gas bloat syndrome,

dysphagia (trouble swallowing), dumping
syndrome, excessive scarring, and rarely,
achalasia. The procedure sometimes fails
over time, requiring a second surgery to
make repairs.
[edit] Prognosis
A hiatus hernia per se does not cause any
symptoms. The condition promotes reflux of
gastric contents (via its direct and indirect
actions on the anti-reflux mechanism) and
thus is associated with gastroesophageal
reflux disease (GERD). In this way a hiatus
hernia is associated with all the potential
consequences of GERD - heartburn,
esophagitis, Barrett's esophagus and
esophageal cancer. However the risk
attributable to the hiatus hernia is difficult to
quantify, and at most is low.[citation needed]
Besides discomfort from GERD and
dysphagia, hiatal hernias can have severe
consequences if not treated. While sliding
hernias are primarily associated with
gastroesophageal acid reflux, rolling hernias
can strangulate a portion of the stomach
above the diaphragm. This strangulation can
result in esophageal or GI tract obstruction
and the tissue can even become ischemic
and necrose.
Another severe complication, although very
rare, is a large herniation that can restrict the
inflation of a lung, causing pain and
breathing problems.
Most cases are asymptomatic.
[edit] Epidemiology
Incidence of hiatal hernias increases with
age; approximately 60% of individuals aged
50 or older have a hiatal hernia.[5] 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.
According to Dr. Denis Burkitt, "Hiatus
hernia has its maximum prevalence in
economically developed communities in
North America and Western Europe....In
contrast the disease is rare in situations
typified by rural African communities."[3]
Burkitt attributes the disease to insufficient
dietary fiber and the use of the unnatural
sitting position for defecation. Both factors
create the need for straining at stool,
increasing intraabdominal pressure and
pushing the stomach through the esophageal
hiatus in the diaphragm.[6]
[edit] Notes and references
1. ^ 01011 at CHORUS

2. ^ Lawrence, P. (1992). Essentials of

General Surgery. Baltimore: Williams &

Wilkins. p. 178. ISBN 0-683-04869-4.
3. ^ Burkitt DP (1981). "Hiatus hernia: is
a b

it preventable?". Am. J. Clin. Nutr. 34

(3): 428–31. PMID 6259926.
http://www.ajcn.org/cgi/reprint/34/3/428.
pdf.
4. ^ Lange CMDT 2006

5. ^ Goyal Raj K, "Chapter 286. Diseases

of the Esophagus". Harrison's Principles

of Internal Medicine, 17e.
6. ^ Sontag S (1999). "Defining GERD".

Yale J Biol Med 72 (2-3): 69–80.

PMID 10780568.
[edit] External links
Wikimedia Commons has media related
to: Hiatal hernia
 •01011 at CHORUS
[show]
v•d•e
Digestive system · Digestive disease ·
Gastroenterology (primarily K20–K93,
530–579)

U Esophagitis (Candidal,
p Herpetiform) ·
p rupture (Boerhaave syndrome,
e Mallory-Weiss syndrome) ·
r UES (Zenker's diverticulum) ·
LES (Barrett's esophagus) ·
G Esophageal motility
Esophagus
I disorder (Nutcracker esophagus,
Achalasia, Diffuse esophageal
t spasm, Gastroesophageal reflux
r disease (GERD)) ·
a Laryngopharyngeal reflux
c (LPR) · Esophageal stricture ·
t Megaesophagus
 Gastritis (Atrophic, Ménétrier's
disease, Gastroenteritis) · Peptic
(gastric) ulcer (Cushing ulcer,
Dieulafoy's lesion) · Dyspepsia ·
Pyloric stenosis · Achlorhydria ·
Stomach
Gastroparesis · Gastroptosis ·
Portal hypertensive gastropathy ·
Gastric antral vascular ectasia ·
Gastric dumping syndrome ·
Gastric volvulus

LSmall intestine/ Enteritis (Duodenitis,

o(duodenum/jejunum/iJejunitis, Ileitis) —
wleum) Peptic (duodenal)
e ulcer (Curling's
r ulcer) —
Malabsorption:
G Coeliac · Tropical
I sprue · Blind loop
syndrome ·
t Whipple's · Short
r bowel syndrome ·
a Steatorrhea · Milroy
c disease
t
: Appendicitis ·
Colitis (Pseudomembr
I anous, Ulcerative,
n Ischemic,
t Microscopic,
e Collagenous,
s Lymphocytic) ·
tLarge intestine Functional colonic
i(appendix/colon) disease (IBS,
n Intestinal
a pseudoobstruction/Ogi
l lvie syndrome) —
/ Megacolon/Toxic
megacolon ·
e Diverticulitis/Divertic
n ulosis
t
e
r Enterocolitis (Necrotiz
o ing) · IBD (Crohn's
p disease) — vascular:
a Abdominal angina ·
t Mesenteric ischemia ·
h Angiodysplasia —
y Bowel obstruction:
Large and/or small
Ileus ·
Intussusception ·
Volvulus · Fecal
impaction —
Constipation ·
Diarrhea (Infectious) ·
Intestinal adhesions

Proctitis (Radiation
proctitis) · Proctalgia
Rectum
fugax · Rectal
prolapse · Anismus

Anal canal Anal fissure/Anal

fistula · Anal abscess
 · Anal dysplasia ·
Pruritus ani

G
I

b
l
e
e
Upper (Hematemesis, Melena) ·
d
Lower (Hematochezia)
i
n
g
/
B
I
S

A
Liver Hepatitis (Viral hepatitis,
c Autoimmune hepatitis,
c Alcoholic hepatitis) ·
e Cirrhosis (PBC) · Fatty
s liver (NASH) ·
s vascular (Hepatic veno-
o occlusive disease, Portal
r hypertension, Nutmeg liver) ·
y Alcoholic liver disease · Liver
failure (Hepatic encephalopathy,
Acute liver failure) · Liver
abscess (Pyogenic, Amoebic) ·
Hepatorenal syndrome · Peliosis
hepatis

Cholecystitis ·
Gallstones/Cholecystolithiasis ·
Cholesterolosis · Rokitansky-
Gallbladder
Aschoff sinuses ·
Postcholecystectomy syndrome ·
Porcelain gallbladder

Bile duct/ Cholangitis (PSC, Secondary

other sclerosing cholangitis,
biliary tree
 Ascending) ·
Cholestasis/Mirizzi's syndrome ·
Biliary fistula · Haemobilia ·
Gallstones/Cholelithiasis
common bile
duct (Choledocholithiasis,
Biliary dyskinesia) · Sphincter
of Oddi dysfunction

Pancreatitis (Acute, Chronic,

Hereditary, Pancreatic abscess) ·
Pancreatic Pancreatic pseudocyst ·
Exocrine pancreatic
insufficiency · Pancreatic fistula

A Diaphragmatic (Congenital) ·
b Hiatus
d Inguinal (Indirect, Direct) ·
Hernia
o Umbilical · Femoral · Obturator ·
m Spigelian
i lumbar (Petit's, Grynfeltt-
n Lesshaft)
o undefined location (Incisional ·
p Internal hernia)
e
l
Peritonitis (Spontaneous bacterial
v
Peritonealperitonitis) · Hemoperitoneum ·
i
Pneumoperitoneum
c

M anat(t, g, noco/cong proc,

: p)/phys/de /tumr, drug(A2A/2B/3/4/5
DI vp/cell sysi/epon /6/7/14/16)
G

[show]
v•d•e
Congenital malformations and
deformations of digestive system (Q35-
Q45, 749-751)

U
Tongue, Cleft lip and palate · Van der
pmouth and Woude syndrome · tongue
ppharynx (Ankyloglossia, Macroglossia,
e Hypoglossia)
r
EA/TEF (Esophageal atresia:
G types A, B, C, and D,
I Tracheoesophageal fistula: types
EsophagusB, C, D and E)
t esophageal rings (Esophageal
r web · upper, Schatzki ring ·
a lower)
c
tStomach Pyloric stenosis · Hiatus hernia

L Intestinal atresia (Duodenal

o atresia) · Meckel's
w diverticulum · Hirschsprung's
Intestines
e disease · Intestinal malrotation ·
r Dolichocolon · Enteric
duplication cyst
G
IRectum/analImperforate anus · Persistent
canal cloaca
t
r
a
c
t

Annular pancreas · Accessory

A pancreas · Johanson–Blizzard
cPancreassyndrome
c
e Pancreas divisum
s
sBile Choledochal cysts (Caroli
oduct disease) · Biliary atresia
r
yLiver Alagille syndrome · Polycystic
liver disease

M: anat/dev noco/cofa(c)/cogi/tumr proc

MO p , sysi (peri),
 U drug
(A1)

M anat(t, g, noco/cong proc,

: p)/phys/de /tumr, drug(A2A/2B/3/4/5
DI vp/cell sysi/epon /6/7/14/16)
G
Retrieved from
"http://en.wikipedia.org/wiki/Hiatus_hernia"
Categories: Hernias | Congenital disorders
of digestive system
Hidden categories: All articles with
unsourced statements | Articles with
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