Хіатальна (діафрагмальна) грижа

Etiology of hiatus hernia is usually unknown, but a hiatus hernia is thought to be acquired through stretching of the fascial attachments between the esophagus and diaphragm at the hiatus (the opening through which the esophagus traverses the diaphragm).

There are 2 main types of hiatus hernia:

• Sliding hiatus hernia (most common): Gastroesophageal junction and a portion of the stomach are above the diaphragm.

• Paraesophageal hiatus hernia: Gastroesophageal junction is in the normal location, but a portion of the stomach is adjacent to the esophagus in the diaphragmatic hiatus.

Less commonly, hiatus hernias have both sliding and paraesophageal components, or involve other organs (1). Hernias may also occur through other parts of the diaphragm (see also Diaphragmatic Hernia).

Розуміння діафрагмальної кили

A hiatus hernia is an abnormal bulging of a portion of the stomach through the diaphragm.

Up to approximately 94% of patients with gastroesophageal reflux disease (GERD) have some degree of hiatus hernia and up to approximately 67% of patients with hiatus hernia have GERD (2, 3); however, a sliding hiatus hernia is a common incidental finding on imaging (4, 5), therefore the relationship of hernia to symptoms is unclear.

Most patients with a sliding hiatus hernia are asymptomatic (1), 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.

• Barium swallow

• Sometimes upper endoscopy

• Sometimes high-resolution esophageal manometry

Barium swallow is the diagnostic test of choice for hiatus hernia; endoscopy may also be used but is less sensitive than a barium swallow (1, 2). High-resolution esophageal manometry may be used as a complementary test to improve sensitivity of either barium swallow or endoscopy. Hiatus hernia is also often discovered incidentally on chest radiograph or chest or abdominal CT scan.

Рентгенографія після проковтування барію демонструє ковзну грижу стр...

Сховати деталі

This image shows a sliding hiatus hernia measuring 5 centimeters (5 cm) in axial length (dashed line indicates the diaphragmatic border).

© Springer Science+Business Media

Hernias can also be seen with upper endoscopy.

Hiatus Hernia

Сховати деталі

Image provided by David M. Martin, MD.

• Sometimes surgical repair

• Sometimes a proton pump inhibitor

An asymptomatic sliding hiatus hernia requires no specific therapy (1). For patients with accompanying GERD, therapy with a proton pump inhibitor should be considered.

Surgical repair of a sliding hiatus hernia should be considered if GERD is present (1); surgery consists of relieving the hernia and a fundoplication. Symptomatic paraesophageal hernias should generally be surgically repaired. Evidence is lacking regarding the appropriateness of surgery in asymptomatic paraesophageal or more complex hernias (2).