Hiatus hernias are often associated with other upper gastrointestinal disease. In most cases, treatment should be directed at the primary symptomatic lesion.
- Complaints of heartburn, acid reflux, waterbrash and dysphagia or odynophagia often lead to the discovery of a sliding hiatus hernia.
- Sliding and paraoesophageal hernias may occasionally present with iron deficiency due to chronic blood loss, possibly resulting from a chronic gastric ulcer within a hernia or from erosions along gastric folds.
- Paraoesophageal hernias have some associations not usually encountered with sliding hernias. These include chest pain, early satiety, dyspnoea and, rarely, infarction.
- It is generally the associated symptoms that require management rather than the hernia itself, although large or incarcerated hernias may require surgical management.
- A single endoscopy (with biopsy if indicated) to detect or exclude Barrett’s epithelium should be considered in the evaluation of most patients, especially those aged over 40 at initial presentation, those who fail to make a good response to standard dose therapy or those who have atypical symptoms.