• In hiatal hernia of the sliding type the esophagogastric junction is drawn upward through the stretched esophageal hiatus of the diaphragm; in the rolling type, the esophagogastric junction is normally situated but an adjacent portion of the cardiac part of the stomach is squeezed in beside it. The two types therefore cause different symptoms.
Although the most frequent symptoms are dysphagia, heartburn, and pain, they vary widely and are sometimes absent. The treatment depends on the symptoms, for hiatal hernias are rarely responsible for severe illness or complications.
In the first case cited, reflux of gastric contents had caused burning sensations that were explained by the finding of esophagitis by direct esophagoscopic examination. The hernia was of the sliding type, and the symptoms subsided during five months of conservative treatment with a bland diet and antacids.
The second case was complicated by the presence of a duodenal ulcer. Measurements of motility and the use of drugs to abolish hypermotility showed that both chemical and mechanical factors were involved in the causation of symptoms, and the heartburn was relieved by the patient sitting up, drinking water, or taking an antacid.
Texter EC, Smith HW, Sippy HI, Barborka CJ. HIATAL HERNIA AND RELATED DISORDERS OF THE ESOPHAGOGASTRIC JUNCTION. JAMA. 1956;160(10):830–833. doi:10.1001/jama.1956.02960450012003
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