Hiatus hernia

Question 1

What is a sliding hiatus hernia?

Answer 1

The gastro-oesophageal junction slides up into the chest.
Acid reflux often happens as the lower oesophageal sphincter becomes less competent in many cases.
80% of hiatus hernias.

Question 2

What is a paraoesophageal hernia (rolling hiatus hernia)?

Answer 2

The gastro-oesophageal junction remains in the abdomen but a bulge of the stomach herniates up unto the chest alongside the oesophagus.
As the gastro-oesophageal junction remains intact, GORD is less common.
20% of hiatus hernias.

Question 3

What are the clinical features of a hiatus hernia?

Answer 3

Common: 30% of patients >50yrs, especially obese women.

Although most small hernias are asymptomatic, patients with large hernias may develop GORD.

Question 4

What imaging techniques are used for hiatus hernias?

Answer 4

Upper GI endoscopy visualises the mucosa (oesophagitis?) but cannot reliably exclude a hiatus hernia.
CT chest with IV contrast may be used to visualise the rolling component of a paraoesophageal hernia.

Question 5

What is the treatment of hiatus hernias?

Answer 5

Lose weight.
Treat GORD.
Surgery indications: intractable symptoms despite aggressive medical therapy, complications.
Although paraoesophageal hernias may strangulate, the risk of this drops dramatically after 65yrs.
Prophylactic repair is only undertaken un those considered at high risk, due to operative mortality (1-2%).