- Protrusion of intra-abdominal contents through an enlarged oesophageal hiatus of the diaphragm.
- Risk factors include obesity, increased intra-abdominal pressure from various conditions, and a previous hiatal operation.
- May be asymptomatic or may present with heartburn, dysphagia, odynophagia, hoarseness, asthma, chest pain, or haematemesis, or some combination of these.
- Contrasted upper GI series (also known as an upper GI or as a barium oesophagram) is the key investigation.
- Treatment depends on the patient's symptoms and the anatomical configuration of the hernia.
- Uncomplicated sliding hiatal hernias are treated symptomatically with medical therapy, although some patients may select surgical therapy. Complicated hiatal hernias (those with bleeding, volvulus, or obstruction) have a stronger indication for surgical repair.
- Complications include obstruction, bleeding, volvulus with and without strangulation or necrosis, and Barrett's oesophagus.
Last updated: Apr 22, 2013