Hiatal hernia refers to the protrusion of part of the stomach sac into the thoracic cavity through the esophageal hiatus. It is mainly caused or triggered by factors such as congenital dysplasia of the diaphragmatic crura, relaxation of the esophageal ligaments, and increased intra-abdominal pressure.

bubble_chart Diagnosis

Medical History and Symptoms:

May be completely asymptomatic; some patients may present with retrosternal pain and regurgitation. It is important to understand the timing of epigastric or retrosternal pain episodes, their relationship to eating and body position, and whether there is radiation of pain.

Physical Examination Findings:

No specific findings.

Auxiliary Examinations:

Diagnosis primarily relies on X-ray examination. Routine chest fluoroscopy and plain chest films should pay attention to the presence of gas-filled sacs and air-fluid levels behind the heart or on both sides of the cardiac shadow. During barium swallow examination, observe for the presence of a supradiaphragmatic hernial sac and gastric mucosal shadows within the sac, and note the appearance of the supradiaphragmatic esophagogastric ring. If one or more of the above signs are present on barium meal examination, the diagnosis of sliding hiatal hernia can be largely confirmed. Endoscopy can be used to exclude esophageal ulcers, inflammation, strictures, and space-occupying sexually transmitted disease lesions, and may reveal upward displacement of the dentate line.

bubble_chart Treatment Measures

After a clear diagnosis, medical treatment can be initially adopted to alleviate reflux symptoms. This includes elevating the head of the bed, avoiding increased abdominal pressure, losing weight, and maintaining a low-fat diet. Avoid smoking, alcohol, and heavy meals before bedtime. Medications such as gastrointestinal motility agents (e.g., cisapride) and acid suppressants (e.g., cimetidine) can be used. If medical treatment proves ineffective, symptoms remain persistent and severe, or serious complications arise, surgical intervention should be considered. Common surgical methods include repairing the hiatal hernia with esophagogastric fixation, gastropexy with anterior fundoplication, and highly selective vagotomy.