Hiatus Hernia: Undervalued Cause of Acid Reflux

Diaphragam is a muscular wall which separates chest cavity from abdomen cavity. Hiatus is an opening in the diaphragam through which esophagus enters from thorax into the abdomen. A hiatus hernia occur when stomach most commonly or other abdomen organs enters into thorax through this opening.

Types of Hiatus Hernia

There are two types of hiatus hernia one is sliding and other is paraesophageal. In sliding hernia GE junction migrates into the thorax.In Paraesophageal hernia GE junction remains stable, stomach most commonly or other abdomen organs rolls into the thorax through side of esophagus
Most commonly patient present with features of acid reflux such as heartburn. Heartburn is defined as pressure sensation localized to epigastric and retrosternal area which does not radiate to back.As the disease become more severe patient complain of regurgitation of digested food. Dysphagia occur due to mechanical obstruction to food.Patient may complain of chest pain

Upper GI Endoscopy is first step to rule out other disorders whose symptoms mimics with hiatus hernia. It also grades the esophagus injury severity due to acid reflux. Esophagus manometery and Esophagogram are other investigations which are also done. CECT chest and upper abdomen is helpful in large paraesophagus hernia for management

Medical Treatment
Proton pump inhibitors and life style modification are first step. Pantoprazole will reduce the heartburn. Weight reduction is important. Eat small but frequent meal. Do not lie immediately after food intake

Surgical Management
Failed medical therapy, Large hiatus defect, Herniation of other abdomen organs are indications for surgery. The standard surgical procedure is reduction of hernia contents with repair of hiatus and fundoplication. It is done Laparoscopically

Dr Amit Jain MS MCh (GI Surgery) Senior Consultant Max Hospital Patparganj Delhi & Vaishali Ghaziabad is best Laparosopic Surgeon for Laparoscopic Fundoplication Surgery. Call us at 7351088686 for your queries

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