Diagnosis

Esophageal hiatal hernia

Etiology

Cause

• Congenital (children): [piw]

  • Congenital defect in infants and children causing gastroesophageal reflux, feeding problems, malnutrition and suppression of growth

• Acquired (adults): Hiatal hernia in adults can lead to reflux and esophagitis

  • Traumatic [ozu]

  • Non-traumatic:

    • Sliding hiatal hernia (95% of hiatal hernias, often asymptomatic) [swn]

    • Para-esophageal hiatal hernia (require surgical treatment)

Pathophysiology [swn]

1. Increased intraabdominal pressure (overweight, pregnancy, ascites, chronic constipation, sneezing, chronic coughing, chronic obstructive pulmonary disease)

2. Negative pressure in the chest

3. Congenital anatomical defects

4. Short esophagus (chronic esophagitis --> fibrosis)

5. Old age (muscle weakening and loss of elasticity)

Complications (paraesophageal hiatal hernia) [nrt]

• Bleeding

• Incarceration

• Obstruction

• Gastric volvulus

• Perforation

• Surgical complications: pneumothorax, gastro/esophageal/hepato/splenic injuries, and dysphagia

Epidemiology

Prevalence per 100.000 [87s]

Approach

• Barium contrast study

• Endoscopy

• Mannometry

• CT thorax/abdomen

Treatment

1. Congenital (infants and children): Open or laparoscopic herniorrhaphy

2. Paraesophageal hiatal hernia: require surgical repair due to risk of complications (bleeding, incarceration, obstruction and perforation) [nrt]

3. Sliding hiatal hernia: usually do not require surgical treatment. If symptoms (GERD):

   • Lifestyle modifications: weight loss, elevation of head of bed

   • Medication: antacids, prokinetics, H2-receptor blocker and proton pump inhibitor

   • Surgery:

     • Open or laparoscopic herniorrhaphy

     • Nissen fundoplication (360° wrap)

Differential diagnoses

Achalasia, Acute laryngitis, Angina pectoris, Esophageal cancer, Esophageal diverticula, Esophageal perforation, Esophageal spasm, Esophagitis, Gastroesophageal reflux disease, Lung cancer, Myocardial infarction, Pneumonia