VOL: 99, ISSUE: 27, PAGE NO: 28
WHAT IS IT?
A structural abnormality in which a portion of the stomach protrudes upwards through the diaphragm.
TYPES OF HIATUS HERNIA
Sliding hiatus hernia (the most common) is where an unusually short oesophagus, that ends above the diaphragm, pulls a part of the stomach upwards into the thorax. The sliding movement is due to the normal shortening of the oesophagus by muscular contracture during swallowing (Waugh and Grant, 2002).
Rolling hiatus hernia (or para-oesophageal hernia) is where an abnormally large opening in the diaphragm allows a pouch of stomach to roll upwards into the thorax beside the oesophagus (Waugh and Grant, 2002). This condition can present as a surgical emergency.
The long-term effects can be oesophagitis or oesophageal stricture resulting in dysphagia.
- Congenital factors.
- Eating large meals, particularly at night.
- Increasing age: hiatus hernia occurs most frequently from middle age onwards (Howie et al, 2001).
- Bending and lying postures.
- Wearing tight clothing around the waist.
- Hiatus hernia is four times more common in women than in men (Howie et al, 2001).
SIGNS AND SYMPTOMS
- Heartburn - a painful burning sensation in the oesophagus, just below the sternum. This is due to gastro-oesophageal reflux, a back-flow of gastric acid into the oesophagus. It often worsens on bending or lying down.
- Dysphagia due to inflammation, muscle spasm or ulceration as a result of reflux oesophagitis.
- Recurrent pneumonitis due to aspiration.
- Complications can include persistent reflux, inhalation pneumonia and chronic blood loss anaemia (McLatchie and Leaper, 2002).
- Dysphagia; feeling of fullness, distension and chest discomfort after meals.
- Cardiac arrythmias.
- Complications can include gangrene and gastric ulceration (McLatchie and Leaper, 2002).
- Medical history.
- Barium swallow and meal.
- X-ray (the condition is sometimes picked up on a routine chest X-ray).
Sliding: treatment should aim to alleviate the discomfort caused by reflux. Antacids (such as Gaviscon) can provide symptom relief as they form a temporary layer over stomach contents. Protein pump inhibitor (PPI) medication can help to inhibit acid secretion completely.
Rolling: surgical treatment may be required in view of the high risk of complications.
Health advice concerning: smoking cessation; weight loss; small frequent meals at regular intervals; posture; bending and lifting in the workplace; sleeping with an extra pillow.
Reflux can be very distressing and can be mistaken for angina.