(See also Overview of Esophageal and Swallowing Disorders Overview of Esophageal and Swallowing Disorders The swallowing apparatus consists of the pharynx, upper esophageal (cricopharyngeal) sphincter, the body of the esophagus, and the lower esophageal sphincter (LES). The upper third of the esophagus... read more .)
There are 2 main types of hiatus hernia:
Hernias may also occur through other parts of the diaphragm (see Diaphragmatic Hernia Diaphragmatic Hernia Diaphragmatic hernia is protrusion of abdominal contents into the thorax through a defect in the diaphragm. Lung compression may cause persistent pulmonary hypertension. Diagnosis is by chest... read more ).
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 Symptoms and Signs Incompetence of the lower esophageal sphincter allows reflux of gastric contents into the esophagus, causing burning pain. Prolonged reflux may lead to esophagitis, stricture, and rarely metaplasia... read more 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.