Hiatal Hernia

What is a Hiatus Hernia?

It is the passage of a permanent or intermittent portion of the stomach through the esophageal hiatus (or hiatus) of the diaphragm. This passage of the upper end of the stomach into the hiatus occurs when the fastening means of the stomach and the lower esophagus are failing.

In 90% of cases, there are sliding up the cardia (upper part of the stomach) and leaving the abdomen and is located in the thorax. The causes are such as increased pressure in the abdomen, obesity, congenital shortening of the esophagus.

In 10% of cases there bearing the fundus of the stomach passes through the aperture diaphragm while the lower esophagus and the cardia remain in place. The cause is most often a congenital defect of the hiatus of the diaphragm, it may also be a trauma.

Hiatal hernia is the most common lesions of the gastrointestinal tract.

Signs of the disease

The GERD symptom is the most evocative (burn behind the breastbone) especially if postural (pain increases when increasing the pressure on the abdomen). but other signs may suggest the diagnosis:

•  Pain on swallowing (dysphagia esophagitis fears);
• Pain in the pit of the stomach;
•  A discrete anemia with pallor and fatigue due to micro-gastrointestinal bleeding;
• Venous thrombosis of the lower limbs (phlebitis);
•  Vomiting of blood (hematemesis). 

Other violations of the digestive tract are often associated and should be pursued systematically: gallstones, ulcers, gastritis, colonic diverticulosis. Similarly, it is usual to find a hiatal hernia in recent.

Examinations and Tests

Already on chest radiograph and lateral views, the practitioner may sometimes note the absence of gastric air pocket. This is especially the transit oesogastroduodénal (UGI), followed by a fluoroscopy screen, which will show the possible hiatal hernia and gastroesophageal reflux.

Fibroscopy research confirms the diagnosis and complications (esophagitis gastroesophageal reflux).

Treatment

Rules of hygiene and nutrition are the same as those of gastroesophageal reflux  :

• Lose weight if overweight;
• Split and food intake rather do 5 or 6 small light meals 2 meals abundant;
• Avoid soft drinks, spices, coffee, fats and alcohol, dressing, fruit acids;
• Avoid foods such as slow-digesting fatty dishes;                     
• Avoid tobacco;
• Take the evening meal before bed time and avoid napping after lunch;
• Avoid wearing girdles, corsets or belts too tight;                     
• Elevate the head of the bed;
• Avoid leaning forward posture.

In sliding hernias, surgical treatment is indicated if there is a significant and troublesome reflux despite correct treatment or in case of severe esophagitis.

Rolling hernias are most often made. The intervention consists of a gastropexy (attachment of the fundus of the stomach to the underside of the diaphragm).

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