hiatal

Hiatal is an anatomical term relating to the hiatus, the opening in the diaphragm through which the esophagus passes. It is most commonly encountered in reference to hiatal hernia, a condition in which abdominal contents protrude through the esophageal hiatus into the mediastinum. The esophageal hiatus is located at roughly the level of the T10 vertebra and is bounded by the diaphragmatic crura.

A hiatal hernia is typically classified into two main types. Sliding hiatal hernia is the most common form, where the gastroesophageal junction and part of the stomach slide above the diaphragm into the thorax. Paraesophageal (or rolling) hiatal hernia occurs when part of the stomach herniates beside the esophagus while the gastroesophageal junction remains below the diaphragm. Paraesophageal hernias can be more prone to complications such as obstruction or strangulation, though they are less common than sliding hernias.

Symptoms vary. Many hiatal hernias are asymptomatic. When symptoms occur, they are often related to gastroesophageal reflux and may include heartburn, regurgitation, chest or epigastric pain, dysphagia, belching, and fullness after meals. Large paraesophageal hernias can cause early satiety, shortness of breath, or iron deficiency anemia from occult bleeding.

Diagnosis is typically made with imaging and endoscopy. A barium swallow study is commonly used to define hernia type and size, while upper endoscopy assesses mucosal health. Esophageal manometry and adjunct imaging (CT or MRI) may be employed in select cases.

Management ranges from observation to treatment. Many cases require no intervention. Lifestyle measures such as weight loss, head-of-bed elevation, smaller meals, and avoidance of trigger foods can help. Pharmacologic therapy (for example, proton pump inhibitors) reduces reflux symptoms. Surgical repair is considered for persistent symptoms despite optimized medical therapy or for paraesophageal hernias, involving reduction of the hernia, cruroplasty, and often fundoplication; the approach may be open or laparoscopic, with mesh used variably.