Types And Symptoms Of Hiatus Hernia: Diagnosis And Treatment

Types And Symptoms Of Hiatus Hernia: Diagnosis And Treatment . Hiatus hernia is defined as presence of a pouch of gastric mucosa within thoracic cage.

• It is commonly seen in middle aged obese females.
• It may be congenital.
• It can be due to conditions which raise intra-abdominal pressure like obesity, pregnancy, ascites or abdominal tumors.
• It may follow surgical operations like partial gastrectomy or vagotomy.

Hiatus hernia can be classified into two types.

Sliding type- It is the commonest variety. In this type there is a simple upward slide of stomach with esophago-gastric junction through the hiatus into chest.

Rolling type- Here esophago-gastric junction is within abdominal cavity, but part of gastric fundus protrudes through the hiatus into the chest.

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Symptoms due to reflux

• Retro-sternal chest pain which is aggravated by stooping or lying down soon after meals.
• Heart burn or regurgitation of acidic fluid.
• Dysphagia (pain while swallowing) due to esophageal muscle spasm or esophagitis.

Symptoms due to pressure

It can be either due to dilated esophagus and or gastric pouch on surrounding structures.

• From pressure on mediastinum- dyspnoea (difficulty in breathing), palpitation, cough and anginal pain.
• From pressure on diaphragm- hiccup, spasmodic pain.

Diagnosis For Hiatus Hernia

• X-ray of chest: If a sliding hernia is large, it may be seen as retro-cardiac shadow with fluid level.
• Barium swallow test to assess hernia size and development of complications.
  
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• Endoscopy and biopsy is mainly of value in assessment of esophagitis and consequent bleeding, ulceration and stricture formation.

Treatment Options For Hiatus Hernia

• To minimize gastro-esophageal reflux,

• Elevate bed head by 20cms.
• Avoid posture precipitating the reflux e.g. bending, stooping etc.
• Avoid eating of large meals.
• No food or drinks for 3 to 4 hours before bedtime.
• Reduce weight if obese.
• Strictly no smoking.
• Avoid all non-steroidal pain killers.
• Avoid foods which provoke symptoms e.g. coffee.
• Reduce gastric acidity and pepsin secretion with antacids prescribed by your doctor.
• Increase tone of lower esophageal sphincter with medicines in consultation with the doctor.

Hiatus Hernia Surgical Treatment

Surgery consists of restoration of intra-abdominal segment of esophagus into abdomen, repairing the hiatus and enveloping lower esophagus by gastric fundus (fundoplication).

Indications of surgery

• No relief with conservative treatment.
• Development of complications like peptic ulcer, esophagitis or strangulation of hernia.
• Nocturnal aspiration of regurgitated material into lungs causing pneumonia.