HIATUS HERNIA

It is displacement of stomach into the chest thtough
oesophageal opening of the diaphragm. Most patients are
elderly, past 40 years. This disorder is of two types:
(a) Sliding. Stomach is pushed into the thorax, in line
with the oesophagus. Reflux oesophagitis is common
and may ·give rise to ulceration and stenosis.
Haematemesis may occur. It is caused by raised
intra-abdom inal pressure.
(b) Paraoesophageal. A part of the stomach along with
its peritoneal covering passes up into the thorax by
the side of oesophagus. The gastro-oesophageal
junc tion still remains below the diaphragm and the
angle between oesophagus and stomach is maintained.
There is no reflux oesophagitis in this type of
hernia. The main symptom is dyspnoea on exertion
due to position of stomach in the thorax, and sometimes
bleeding.
Diagnosis of both types of hiatus hernia can be made
by barium swallow.
Treatment
Mainly it is surgical; the hernia is reduced and diaphragmatic
opening repaired. Early cases and those unfit for
surgery may be treated conservatively to reduce reflux
oesophagitis by measures such as ( i) sleeping with head
and chest raised; (ii) avoidance of smoking; (iii) use of
drugs that reduce acidity (antacids and cimetidine); (iv)
reduction of obesity; and (v) attention to the causes
which raises intra-abdominal pressure.