Hiatal hernia – colloquially called diaphragmatic hernia – (synonyms: Hernia diaphragmatica; Hiatus hernia; Diaphragmatic hernia; ICD-10-GM K44.-: Hernia diaphragmatica) refers to a hernia involving the diaphragm in the region of the esophageal hiatus (passage of the esophagus). This hernia displaces all or part of the stomach into the chest.
Hiatal hernia can be congenital (congenital) or acquired (the more common case).
The following forms of hiatal hernias can be distinguished:
- Cardiofundal malposition – precursor of the sliding hernia.
- Axial sliding hernia (parts of the stomach slide along the longitudinal axis of the esophagus (food pipe) through the hiatus oesophageus (diaphragmatic passage)) – this form represents about 90% of hiatal hernias; the symptoms and therapy of axial sliding hernia correspond to those of gastroesophageal reflux disease (pathological reflux of acid gastric juice and other gastric contents into the esophagus (food pipe)) (Approximately 50% of all people over 50 years of age have an axial sliding hernia).
- Paraesophageal hernia (here, part of the stomach (mostly parts of the gastric fundus) next to the esophagus (“paraesophageal”) into the mediastinum (median in the chest cavity lying space))In severe cases, it can come to the complete displacement of the stomach into the thoracic cavity (= upside-down stomach; thoracic stomach; upside-down stomach).
- Mixed forms of the above hernias (mixed hernia) – rarely exists reflux symptomatology.
Gender ratio: men are more often affected than women. From the age of fifty, the ratio is 2:1.
Frequency peak: the disease occurs predominantly in people over 50 years of age (50% of those affected are older 50 years).
Course and prognosis: In the majority of cases an axial sliding hernia does not cause any symptoms and only needs to be treated if the symptoms are similar to those of reflux disease. In contrast, paraesophageal hernia may lead to life-threatening complications such as incarceration (entrapment of the hernia) or gastric ileus (gastric obstruction). Surgery is then required in these cases.
