Hiatusbråck

Hiatusbråck, or hiatus hernia, is a condition in which a portion of the stomach protrudes through the diaphragmatic esophageal hiatus into the chest. The most common form is sliding hiatusbråck (slidande hiatusbråck), in which the gastroesophageal junction and part of the stomach move above the diaphragm. A less common form is paraesophageal (rolling) hiatusbråck, where part of the stomach herniates beside the esophagus while the junction remains below the diaphragm; this form carries a higher risk of strangulation or obstruction.

Symptoms vary. Many people are asymptomatic. When present, reflux symptoms such as heartburn, regurgitation and dysphagia are typical. Chest discomfort, belching or early satiety may occur. In paraesophageal hernias, symptoms may reflect obstruction or fullness rather than reflux.

Diagnosis typically involves imaging and endoscopy. A barium swallow (upper GI series) can delineate the hernia type; endoscopy assesses mucosal damage from reflux and rules out other causes. CT or manometry may be used in selected cases.

Treatment depends on type, size and symptoms. Small, asymptomatic hernias often require no treatment; lifestyle measures (weight management, head-of-bed elevation, avoiding late meals) and acid suppression with proton pump inhibitors may help reflux symptoms. Large sliding hernias or symptomatic paraesophageal hernias usually require surgery. Laparoscopic repair with cruroplasty to tighten the hiatus and, if needed, fundoplication is common. Mesh reinforcement and gastropexy may be used. Acute paraesophageal hernias with obstruction or strangulation require emergency surgery.

Prognosis is generally favorable with appropriate management; monitoring for reflux-related complications is important.