The diaphragmatic hiatus is the opening that connects the esophagus to the stomach – separates the chest from the abdomen, forming an acute angle that mainly prevents the output of gastric contents into the esophagus (regurgitation). Its standard size is 1.5 inches on average, but for various reasons, including failure of fixation mechanisms, the space can be expanded to 2.5 or 3 inches, creating a gradual deformation of the stomach and functional alterations.

The same membrane stomach sometimes rises gradually changing its original appearance, and stomach contents can come out, driven by pressure to esophageal webs. The consequences of these alterations are the hernia and gastroesophageal reflux.

Diagnosis

Often the patient is unaware that their problem. The first thing you should detect through observation symptomatic, is an internist or general practitioner. If the problem does not improve in gastroenterology in a timely fashion, it indicate an endoscopy.

The hiatal hernia was diagnosed by X-ray and high gastric endoscopy, and by oesophageal pH measurement and esophageal manometry.

Classes

Sliding hiatal hernia. When the stomach goes up into the chest cavity. Paraesophageal hiatal hernia. When the sliding part of the stomach is parallel to the esophagus.

Treatment

Many of the cases handled pharmacology. When you do not improve over time and has identified a greater deformation and stomach acid begins to invade the esophagus, degenerating tissue and cause ulcers and inflammation, there is greater risk for problems such as the so-called Barrett’s esophagus, including cancer . It is therefore advisable to use timely surgery.

Directions

According to specialists, surgical treatment is indicated in cases of sliding hiatal hernias, bulky and those that are associated with severe gastroesophageal reflux with esophagitis, esophageal stricture, bleeding, chronic anemia, and bronchial respiratory symptoms attributable to reflux.

Also added, the failure of medical treatment in hiatal hernia with reflux esophagitis and mild, with symptoms not acceptable to the patient, and sliding hiatal hernia with gastroesophageal reflux with associated disease requiring surgery, this occurs in the ulcer peptic calculous gallbladder disease.

Whenever possible maintain controlled reflux and its consequences, clinical or pathological, treatment should be, in principle, clinical. It is a behavior that is adopted in patients with symptomatic little expressive, especially when there is absolute certainty the existence of hiatal hernia and in patients with serious risk for surgery.

In summary, indications for surgery include instances of esophagitis unresponsive to medical treatment, patients who have complications such as stenosis or major bleeding, and cases of large hernias for which it is not fair to expect improvement in the clinical .