A Family Doctor's Tale - HIATUS HERNIA

DOC I HAVE HIATUS HERNIA

Hiatus Hernia is a protrusion of part of the stomach through the diaphragmatic hiatus (or hole) into the chest.

Two main causes are
1.Congenital
The Hiatus Hernia occur in newborns as a result of the diaphragm to fuse.
There is a familial history.

2.Acquired
a.Sliding -most common type - occurs when the gastroesophageal junction and part of the stomach above the diaphragm may be associated with a short esophagus secondary to esophagitis and stricture of the esophagus from scarring(due to gastric acid)

b.Paraesopphageal :when the gastroesophageal junction is below the the diaphragm and part of the stomach herniates upwards along the esophagus.

Vomiting of the retained food in the part of the stomach stuck in the diaphragm is a natural progression of the condition.

The Symptoms of Hiatus Hernia are:

Most hiatus hernia are asymptomatic.
The most common symptoms are those of esophageal reflux:
1.heartburn aggravated by bending down, lying down, smoking, alcohol, and heavy meals

2.belching, abdominal bloating,

3.acid reflux to the throat

4.nausea, and vomiting of ingested food

5.fullness and pain after eating may be caused by mechanical obstruction of the pouch of the stomach in paraesophagel type of hiatus hernia

6.Respiratory distress may be present in infants due the pressure of the stomach on the lung space.

7.weight loss

8.bleeding

Hiatus Hernia is diagnosed through one or more medical tests:

1.Upper gastrointestinal endoscopy.
The doctor uses an esophagoscope, a thin tube containing a tiny camera, through your mouth  and down into your stomach to look at the stomach lining for erosions and narrowing of the passage of the upper part of the stomach and esophagus

2.MRI of the upper abdomen usually shows the presence of excess stomach content in the lung area above the diaphragm
and presence of hiatus hernia.

The Treatment of Hiatus Hernia is:
The main treatment is usually medical especially for sliding hernia.

1.correction of fluid and electrolyte deficit by intravenous infusion of saline and glucose

2.Antacids:to reduce stomach acid from gastric reflux and thereby help relieve symptoms and promote healing. (Stomach acid irritates the inflamed tissue in the esophagus and the upper stomach.)

3.H2 Antagonist: to reduce to production of acidic gastric juice.(cimetidine, ranididine,omeprazole, Nexium etc)

4. Antispasmodics: anticholinergic drugs like buscopan.librax reduce the spasm in the stomach and esophagus

Surgery:
The surgery involves repair of the diaphragmatic hernia and the return of the stomach to below the diaphragm in the paraesophageal cases of hiatus hernia.

1.Surgical treatment may be necessary in cases with persistant esophageal reflux and severe esophagitis.

2.Paraesophageal hernias are less amenable to medical treatment and often require surgical treatment.

3.Emergency surgery is required in cases of strangulation of the esophagus, esophageal obstruction or perforation.

The Complications of untreated Hiatus Hernia are:
1.strangulation of esophagus

2.obstruction of the esophagus

3.perforated esophagus

Prognosis of Hiatus Hernia is :
1. good to excellent if treated surgically to repair the hernia.

2.medical treatment may work but recurrence rate is high.