(See also Overview of Esophageal and Swallowing Disorders.)
There are 2 main types of hiatus hernia:
Hernias may also occur through other parts of the diaphragm (see Diaphragmatic Hernia).
A sliding hiatus hernia is common and is an incidental finding on x-ray in > 40% of the population; therefore, the relationship of hernia to symptoms is unclear. Although most patients with gastroesophageal reflux disease (GERD) have some degree of hiatus hernia, < 50% of patients with hiatus hernia have GERD.
Most patients with a sliding hiatus hernia are asymptomatic, but chest pain and other reflux symptoms can occur. A paraesophageal hiatus hernia is generally asymptomatic but, unlike a sliding hiatus hernia, may incarcerate and strangulate. Occult or massive gastrointestinal hemorrhage may occur rarely with either type.
An asymptomatic sliding hiatus hernia requires no specific therapy. Patients with accompanying GERD should be treated with a proton pump inhibitor.
For a paraesophageal hernia, repair should be considered because of the risk of strangulation.