Protrusion of intra-abdominal contents through an enlarged esophageal hiatus of the diaphragm.
Risk factors include obesity, increased intra-abdominal pressure from various conditions, and a previous hiatal operation.
May be asymptomatic or may present with heartburn, dysphagia, odynophagia, hoarseness, asthma, chest pain, or hematemesis, or some combination of these.
Contrasted upper GI series (also known as an upper GI or as a barium esophagram) is the key investigation.
Treatment depends on the patient's symptoms and the anatomic configuration of the hernia.
Uncomplicated sliding hiatal hernias are treated symptomatically with medical therapy, although some patients may select surgical therapy. Complicated hiatal hernias (those with bleeding, volvulus, or obstruction) have a stronger indication for surgical repair.
Complications include obstruction, bleeding, volvulus with and without strangulation or necrosis, and Barrett esophagus.
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