Hiatal hernia

Hiatal hernia refers to the protrusion of part of the stomach into the chest through a defect in the diaphragm
There are two types of hiatal hernia: Sliding (95% of cases) and Paraoesophageal

Paraoesophageal Symptoms
Many patients are asymptomatic
Gastro-oesophageal reflux disease (GORD) may occur in those with sliding hiatal hernia.
Gastric volvulus (twisting of the stomach) may occur in those with paraoesophageal hiatal hernia. This results in impaired blood supply and obstruction.

Diagnosis
This condition is mostly diagnosed as an incidental finding on x-ray. However, barium swallow may be performed. In this procedure, the patient drinks a solution of barium which coats the inside of the upper gastrointestinal tract, allowing it to show up on x-ray. Upper gastrointestinal endoscopy may also be performed. This allows the physician to visualise the stomach lining by directing a thin tube with a camera into the stomach.

Treatment
Treatment of sliding hiatal hernias involves treating the resulting GORD. Paraoesophageal hiatal hernia requires surgery to prevent gastric volvulus. This is called gastropexy and involves attachment of the stomach to a fibrous structure called the rectus sheath.