Hiatus hernias

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 the types of hiatus hernias?

Answer 2

• sliding: accounts for 95% of hiatus hernias, the gastroesophageal junction moves above the diaphragm
• rolling (paraoesophageal): the gastroesophageal junctions remains below the diaphragm but a separate part of the stomach herniates through the oesophageal hiatus

Question 3

Risk factors: hiatus hernia

Answer 3

obesity
increased intraabdominal pressure (e.g. ascites, multiparity)

Question 4

Symptoms of hiatus hernia?

Answer 4

• heartburn
• dysphagia
• regurgitation
• chest pain

Question 5

Investigations for hiatus hernias

Answer 5

• barium swallow is the most sensitive test
• given the nature of the symptoms many patients have an endoscopy first-line, with a hiatus hernia being found incidentally

Question 6

Management of hiatus hernia

Answer 6

• all patients benefit from conservative management e.g. weight loss
• medical management: proton pump inhibitor therapy
• surgical management: only really has a role in symptomatic paraesophageal hernias