Hiatus hernia

Question 1

What is a hiatus hernia?

Answer 1

A hiatus hernia describes the herniation of part of the stomach above the diaphragm.

Question 2

What are the two types of hiatus hernias?

Answer 2

1. Sliding: accounts for 95% of hiatus hernias, the gastroesophageal junction moves above the diaphragm.
2. Rolling (paraoesophageal): the gastroesophageal junction remains below the diaphragm but a separate part of the stomach herniates through the oesophageal hiatus.

Question 3

What are the risk factors for hiatus hernia?

Answer 3

1. Obesity
2. Increased intraabdominal pressure (e.g. ascites, multiparity)

Question 4

What are the features of hiatus hernia?

Answer 4

1. Heartburn
2. Dysphagia
3. Regurgitation
4. Chest pain

Question 5

What is the most sensitive test for investigating hiatus hernia?

Answer 5

Barium swallow is the most sensitive test.

Many patients have an endoscopy first-line, with a hiatus hernia being found incidentally.

Question 6

What is the management for hiatus hernia?

Answer 6

1. Conservative management: all patients benefit from weight loss.
2. Medical management: proton pump inhibitor therapy.
3. Surgical management: only really has a role in symptomatic paraesophageal hernias.