Hiatus hernia
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{{Infobox_Disease |
Name = Hiatus hernia |
Image = Hiatalhernia.gif |
Caption = |
DiseasesDB = 29116 |
ICD10 = {{ICD10|K|44||k|40}}, {{ICD10|Q|40|1|q|38}} |
ICD9 = {{ICD9|553.3}}, {{ICD9|750.6}} |
ICDO = |
OMIM = 142400 |
MedlinePlus = |
eMedicineSubj = med |
eMedicineTopic = 1012 |
eMedicine_mult = {{eMedicine2|radio|337}} |
MeshID = 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 (anatomy)|diaphragm]].
==Symptoms==
The symptoms include [[acid reflux]], and pain, similar to heartburn, in the chest and upper stomach.
In most patients, hiatus hernias cause no symptoms. Sometimes patients experience [[heartburn]] and [[Regurgitation (digestion)|regurgitation]], when [[stomach acid]] refluxes back into the [[esophagus]].
==Risk factors==
The following are risk factors for having a hiatus hernia.
*Increased pressure within the [[abdomen]] caused by:
** Heavy lifting or frequent bending over
** Frequent or hard [[coughing]]
** Hard sneezing
**[[Pregnancy]] and delivery
** [[Vomiting|Violent vomiting]]
** Straining with [[constipation]]
**[[Obesity]] (extra weight pushes down on the abdomen increasing the pressure)
** Use of the sitting position for [[defecation]]<ref name="burkitt">Burkitt DP, Hiatus hernia: is it preventable? American Journal of Clinical Nutrition. 34: 428-431,
1981 [http://www.ajcn.org/cgi/reprint/34/3/428.pdf link]</ref> (See epidemiology below)
* [[Heredity]]
* [[tobacco smoking|Smoking]]
* [[Drug use]], such as cocaine.
* [[Stress (medicine)|Stress]]
==Diagnosis==
[[Image:Hiatus-hernia.jpg|thumb|right|[[gastroscopy|Upper GI endoscopy]] depicting hiatus hernia.]]
The diagnosis of a hiatus hernia is typically made through an [[upper GI series]] or [[gastroscopy|endoscopy]].
==Types==
There are two major kinds of hiatus hernia: <ref>{{Chorus|01011}}</ref>
* 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]] beside, and without movement of, the gastroesophageal junction. It is about 100 times less common than the first kind. <ref name="Lawrence">{{cite book| author=[[Peter F. Lawrence|Lawrence, P.]] | title=Essentials of General Surgery| location= Baltimore | publisher= Williams & Wilkins | year = 1992 | page = 178 | ISBN = 0-683-04869-4}}</ref>
A third kind is also sometimes described, and is a combination of the first and second kinds.
==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 management|stress reduction techniques]] may be prescribed, or if overweight, [[weight loss]] may be indicated. Medications that lower the [[lower esophageal sphincter]] (or [[Lower esophageal sphincter|LES]]) pressure should be avoided. Antisecretory drugs like [[proton pump inhibitors]] and [[histamine H2 receptor|H<sub>2</sub> 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 [[Laparoscopic surgery|laparoscopically]]. With proper patient selection, laparoscopic fundoplication has low complication rates and a quick recovery.<ref name="Lange">Lange CMDT 2006</ref>
Complications include [[gas bloat syndrome]], [[dysphagia]] (trouble swallowing), [[Gastric dumping syndrome|dumping syndrome]], excessive scarring, and rarely, [[achalasia]]. The procedure sometimes fails over time, requiring a second surgery to make repairs.
==Complications==
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.
Besides discomfort from GERD and dysphagia, hiatal hernias can have severe consequences for patients 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 even become [[ischemic]] and [[necrosis|necrose]].
Another severe complication, although very rare, is a large herniation that can restrict the inflation of a [[lung]], causing pain and breathing problems.
==Epidemiology==
Hiatus hernias affect anywhere from 1 to 20% of the population.{{Fact|date=February 2007}} 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."<ref name="burkitt" /> 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.
Some substances (such as the herb [[Peppermint]] and the drug [[Guaifenesin]]) can increase the chance of hiatal hernia due to their ability to relax smooth muscles<ref>Mark London, "The Truths and Myths of the use of Guaifenesin for Fibromyalgia" at [http://web.mit.edu/london/www/guai.html http://web.mit.edu/london/www/guai.html]</ref>.
==Notes and references==
<div class="references">
<references/>
</div>
==External links==
* {{Chorus|01011}}
* [http://jaajoe.com/index.php?option=com_content&task=view&id=17&Itemid=40 Living with a Hiatus Hernia - Water: the Cure for Heartburn]
{{Gastroenterology}}
{{Congenital malformations and deformations of digestive system}}
[[Category:Gastroenterology]]
[[Category:Hernias]]
[[de:Hiatushernie]]
[[es:Hernia de hiato]]
[[fr:Hernie hiatale]]
[[it:Ernia iatale]]
[[he:בקע סרעפתי]]
[[ja:食道裂孔ヘルニア]]
[[pl:Przepuklina rozworu przełykowego]]
[[pt:Hérnia de hiato]]
[[fi:Palleatyrä]]
[[sv:Hiatusbråck]]