hiatal hernia : Associated Diseases

Associated Diseases
Barrett’s oesophagus - 96% of Barrett’s oesophagus patients have a hiatus hernia3
Oesophageal adenocarcinoma - increase in risk x6 with hiatus hernia but no reflux and x8 if reflux as well.4

Management
Non-Drug Patients with hiatus hernia should be advised to avoid any factors likely to increase intra-abdominal pressure e.g. tight clothing, corsets.

Nocturnal symptoms may be helped by elevating the head of the bed to reduce postural reflux.

Weight loss should be advised in obese patients and patients who smoke and /or drink should be encouraged to stop.

Drugs Symptomatic relief may be gained by the use of alginates +/- use of proton pump inhibitors, although patients with hiatus hernia may require larger doses for symptom control.

Surgical The presence of a hiatus hernia is a marker for severe GORD .Patients with a hiatus hernia tend to have more severe symptoms and a poorer response to treatment, but it’s presence per se does not alter management strategies.

Indications for surgery in patients with severe GORD include:-

Patients who are unable to comply with therapeutic regimes
Patients who require high doses of drugs
Patients who wish to avoid lifelong medical treatment
The surgical procedure most commonly used involves mobilising the oesophagus in the thorax, bringing it down to restore the intra-abdominal portion and repairing the deficit (modified Nissen procedure).

Oesophageal lengthening combined with fundoplication may be performed during laparoscopic surgery.

Several novel endoscopic techniques have been used in the treatment of GORD with some success, but the results do not separate out patients with hiatus hernia.

Prognosis The majority of patients will gain symptomatic relief from medical or surgical intervention, although a few will go on to develop Barrett’s oesophagus or oesophageal adenocarcinoma.

© EMIS and Patient Information Publications 1997-2006