Causes

This is due to the weakness in the diaphragm at the region of oesophageal opening coupled with sudden increase in the intra abdominal pressure resulting in the herniation of the part of the stomach into the chest cavity

Types of hiatus hernia

• Axial/sliding hernia
• Paraoesophageal /rolling hernia
• Mixed types

Symptoms

In most patients especially sliding hiatus hernia do not cause any symptoms. The symptoms are similar to the symptoms of acid reflux disease, Pain, heart burn, pharyngitis.

Risk factors

• Presence of congenital weakness in the diaphragm
• Smoking
• Alcohol
• Constipation
• Chronic cough
• Heavy weight lifting
• Obesity

 Diagnosis

• Barium swallow will demonstrate the presence of the portion of stomach usually the fundus in the thoracic cavity
• Upper gastrointestinal endoscopy will show the changes in the part of the mucosa of the part of the herniated stomach

Treatment

Axial/sliding hernia - Medical line of management is the treatment of choice

• Antacids to reduce the acid secretion
• Prokinetic agents to reduce the acid reflux into oesophagus
• Lifestyle modification – quit smoking and alcohol, weight reduction, frequent bland diet, head end elevation by six inches while sleeping.

 Paraoesophageal /rolling hernia

 Surgery is the main stay of treatment in this form of the hiatal hernia. The surgical approach can be abdominal or thoracic. But the thoracic approach is  preferred. Surgery includes reduction of the herniated sac, closure and repair of the defect in the diaphragm and acid anti-reflux surgery.

 Complications

• GERD
• Oesophagitis
• Barrets oesophagus,
• Oesophageal carcinoma
• Ulcer, and perforation
• Oesophageal stricture
•  Rollowing type causes volvolus and sudden death.