Section 9. Digestive Disorders

Chapter 123. Hiatus Hernia, Bezoars, and Foreign Bodies

Topics: Introduction | Hiatus Hernia | Bezoars and Foreign Bodies

Hiatus Hernia

Hiatus hernia is a protrusion of a portion of the stomach from its normal position in the abdomen through the diaphragm.

The cause of hiatus hernia is usually unknown. Sometimes it exists from birth. The stomach sometimes protrudes upward through the diaphragm from its normal position in the upper abdomen. This condition sometimes occurs as a birth defect, in which case it is called a diaphragmatic hernia (see Section 23, Chapter 265); in adults, the condition is called hiatus (hiatal) hernia.

See the figure Understanding Hiatus Hernia.

In a sliding hiatus hernia, the junction between the esophagus and the stomach as well as a portion of the stomach itself, all of which are normally below the diaphragm, protrude above it.

In a paraesophageal hiatus hernia, the junction between the esophagus and stomach is in its normal place below the diaphragm, but a portion of the stomach is pushed above the diaphragm and lies beside the esophagus.

Symptoms

More than 40% of the people in the United States have a sliding hiatus hernia. The frequency increases with age, so that the rate climbs to 60% of people older than 60 years of age. Most sliding hiatus hernias are very small, and most people with sliding hiatus hernias have no symptoms. Symptoms that do occur are usually minor. They are usually related to gastroesophageal reflux (see Section 9, Chapter 121) leading to indigestion, typically when a person lies down after eating.

A paraesophageal hiatus hernia may get trapped or pinched by the diaphragm and lose its blood supply. Such a trapping is a serious and painful condition, called strangulation, that requires immediate surgery. Rarely, microscopic or massive bleeding from the lining of the hernia occurs with either type of hiatus hernia.

Diagnosis and Treatment

Usually, x-rays clearly reveal a hiatus hernia, although a doctor may have to press on the abdomen during the procedure.

Often, elevating the head of the bed while sleeping prevents symptoms. Antacids and drugs that prevent acid production also relieve symptoms (see Section 9, Chapter 121). A paraesophageal hiatus hernia may be corrected surgically to prevent strangulation, but such surgery is rarely needed.