Hiatus hernia and Gastroesophageal reflux

Have you ever felt heartburn? It is the pain or discomfort that arises from the upper abdomen or lower chest and spreads upwards to the neck. It feels like a sharp pain or tightness that can sometimes be confused with cardiac pain (a heart attack). Some might describe it as a burning sensation, which gives it the name “heartburn”.

It occurs more frequently while lying down and after meals. Some patients may have a sudden increases in saliva production when it occurs, called a “waterbrash”. Some patients may just have a chronic, recurrent sore throat. Or even “asthma” symptoms at night, i.e. dry coughing.

These symptoms are due to acid reflux from the stomach up to the oesophagus. Gastro-oesophageal reflux disease (GORD, or GERD in the US) is multi-factorial but one of the causes is hiatus hernia. This is the protrusion of the upper end of the stomach from the abdominal space up above the diaphragm into the chest space.

View from the endoscope: looking from the top, i.e. the oesophagus.

View from the bottom: i.e. the stomach. You can see the big space around the scope (the black tube). Normally the stomach-oesophagus junction should hug the tube tightly and there’s no empty space around the tube.

On the left is the normal site of the stomach. On the right is hiatus hernia. The upper end of the stomach has moved up through the diaphragm (represented by the red line)

Usually the treatment is medical. Occasionally, the symptoms may not be resolved and require surgery.

---

Can’t make head or tail of the photo?

The blue line marks the scope. The red line marks the junction between the oesophagus and the stomach. It should be hugging the scope.