There are two main types of hiatal hernia: sliding and paraesophageal. A sliding hernia occurs when the stomach and lower esophagus slide up into the chest cavity through the diaphragm. A paraesophageal hernia involves part of the stomach squeezing through the diaphragmatic opening and landing next to the esophagus. Hiatal hernias often do not cause symptoms but can sometimes lead to heartburn. Treatment involves lifestyle changes and medication to reduce acid production if heartburn is present. Surgery to repair the diaphragmatic opening may be needed in some cases.

1. Hiatal hernia
MURAD A’AMAR
HASHEMITE UNIVERSITY

2. What is hiatal hernia?
 The hiatus is an opening in the diaphragm -- the muscular wall
separating the chest cavity from the abdomen.
 Normally, the esophagus (food pipe) goes through the hiatus and
attaches to the stomach. In a hiatal hernia (also called hiatus
hernia) the stomach bulges up into the chest through that opening

3. Types of hiatal hernia:
 There are two main types of hiatal hernias:
 1- sliding and,
 2- paraesophageal (next to the esophagus).

5. Sliding hernia:
 In a sliding hiatal hernia, the stomach and the section of the
esophagus that joins the stomach slide up into the chest through the
hiatus.
 This is the more common type of hernia.

6. Sliding hernia

7. Paraoesophageal hernia:
 The paraesophageal hernia is less common,
 The esophagus and stomach stay in their normal locations, but part
of the stomach squeezes through the hiatus,
 landing it next to the esophagus.

8. Paraesophagial hernia

9. Paraesophagial hernia:
 Although you can have this type of hernia without any symptoms,
 the danger is that the stomach can become "strangled," or have
its blood supply shut off.

10.  Many people with hiatal hernia have no symptoms,
 but others may have heartburn related to gastroesophageal reflux
disease, or GERD.
 Although there appears to be a link, one condition does not seem
to cause the other, because many people have a hiatal hernia
without having GERD, and others have GERD without having a
hiatal hernia.
 People with heartburn may experience chest pain that can easily
be confused with the pain of a heart attack.

11. What causes hiatal hernia?
 Most of the time, the cause is not known.
 A person may be born with a larger hiatal opening.
 Increased pressure in the abdomen such as from
pregnancy, obesity, coughing, or straining during bowel movements
may also play a role.

12. Who is at risk of hiatal hernia?
 Hiatal hernias occur more often in women,
 people who are overweight,
 and people older than 50

13. How it is diagnosed?
 A hiatal hernia can be diagnosed with a specialized X-ray (using a
barium swallow) that allows a doctor to see the esophagus,
 or with endoscopy.

14. Barium swallow demonstrates hiatal
hernia:

18. Endoscopic view:

21. Medical Treatment:
 When symptoms are due to GERD, the goals of treatment include prevention of
reflux of gastric contents, improved esophageal clearance, and reduction in
acid production. This is achieved in the majority of patients by a combination of
the following:
 Modifying lifestyle factors, STOP SMOKING
 Neutralizing acid or inhibiting acid production by antacids and PPI
 Enhancing esophageal and gastric motility:
 -Domperidone (Motilium®)
 -Metoclopromide (Reglan®, Maxeran®)
 -Levosulpiride (Levobren®, Levopraid®,)
 -Erythromycin

22. Surgical approaches:
 Nissen fundoplication: This procedure involves a 360° fundic wrap
around the gastroesophageal junction. The diaphragmatic hiatus
also is repaired
 Belsey fundoplication: This operation involves a 270° wrap in an
attempt to reduce the incidence of gas bloating and postoperative
dysphagia. It also is preferred when minimal esophageal dysmotility
is suspected.
 Hill repair: the cardia of the stomach is anchored to the posterior
abdominal areas.