Hiatus hernia

When hiatal hernia ( " diaphragmatic hernia " ) a morbid passage of shares of the stomach through the diaphragm in the region of the slot for the passage of the esophagus ( esophageal hiatus ) is called. It belongs to the diaphragmatic hernia.

Normal position

Anatomically normal esophagus passes through the chest cavity from the pharynx to the diaphragm ( see figure, point A ). There, the lowest portion of the esophagus passes through the diaphragm and into the abdominal cavity. Directly below the diaphragm opens the esophagus into the stomach. At this transition is called the lower esophageal sphincter ( LES ) which prevents reverse movement of gastric contents into the esophagus. In the normal anatomical position of the lock mechanism is supported by the muscle tension of the diaphragm.

Molding

Malformation of the cardia

There are different variations of hiatal hernia: The malformation of the cardia ( see figure, point B ) is the mildest form and is a frequent incidental finding at gastroscopy dar. In this malformation is the cardia - ligamentous apparatus that connects the stomach with the diaphragm relaxed. Medical and anatomically the malformation of the cardia by a blunt esophagogastric angle ( angle = His'scher ) is characterized ( unlike the anatomical norm, where this angle is acute, see figure). Clinically preparing this condition only in the rarest of cases complaints.

Axial hernia

The axial hernia ( see figure, letter C) - also known as shear fracture - is with 90 % the most common type of hiatal hernia. Here, the top portion of the stomach through the diaphragm occurs upward into the chest cavity ( such as in a hernia of the diaphragm ). In this pathological situation, the lower closure of the esophagus are no longer supported by the diaphragm. This can result in reflux, that is, the return flow of stomach contents into the esophagus come. This can lead to reflux esophagitis among others (heartburn). However, 90 % of patients are free of symptoms even in this form and do not require further therapy.

The incidence of hernias increases with age, more than half of the over-fifties are affected.

Paraesophageal hiatal hernia

The paraesophageal hiatal hernia ( see figure, letter D) is characterized by the anatomically correct position of the lower esophageal sphincter ( sphincter of the esophagus ) and its full function. However, part of the stomach pushes from below into the chest cavity. In the extreme form of this hiatal hernia and the whole stomach is above the diaphragm are ( Upside-Down Stomach or thoracic stomach). In the clinical course of the paraesophageal hiatal hernia begins with an asymptomatic stage. It follows the simple stage, with belching and a feeling of pressure in the heart area. These symptoms occur mainly after food intake. After that time, complication stage with passage disorders, Inkarzerationen, ulcers and anemia due to chronic bleeding.

Next there are various forms of mixed hernias. In general, the formation of hiatal hernias is favored by lack of exercise and obesity.

Therapy

The heartburn is often combated with drugs by proton pump inhibitors. The various forms of hernia can be treated healing (curative ) surgery. The operations carried out by two methods principles:

Under certain circumstances, both operating principles are also used.

Swell

• Herold, G.: Internal Medicine. Self- Verlag, Cologne, 2005.