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{{Hiatus hernia}}
{{Hiatus hernia}}
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==Overview==
==Overview==
In most cases, sufferers experience no discomfort and no treatment is required. However, when the hiatal hernia is large, or is of the paraesophageal type, it is likely to cause [[esophageal stricture]] and discomfort. Symptomatic patients should elevate the head of their beds and avoid lying down directly after meals until treatment is rendered.  If the condition has been brought on by stress, [[stress management|stress reduction techniques]] may be prescribed, or if overweight, [[weight loss]] may be indicated.  Medications that lower the [[lower esophageal sphincter]] (or [[Lower esophageal sphincter|LES]]) pressure should be avoided.  Antisecretory drugs like [[proton pump inhibitors]] and [[Histamine H2 receptor|H2 receptor]] blockers can be used to reduce acid secretion.   
In most cases, patients experience no discomfort and no treatment is required. However, when a hiatal hernia is large, it is likely to cause [[esophageal stricture]] which results in discomfort. Symptomatic patients benefit from not lying down immediately after meals and also benefit by elevating the head of their beds.  If stress has been idetified as the major riskfactor, [[stress management|stress reduction techniques]] may be practiced, or if overweight, [[weight loss]] may be indicated. Certain medications causes [[lower esophageal sphincter]] (or [[Lower esophageal sphincter|LES]] to relax those medications should be avoided.  Anti-acid drugs like [[proton pump inhibitors]] and [[Histamine H2 receptor|H2 receptor]] blockers can be used to decrease the acid secretion.   
 
==Medical Therapy==
 
* Medications
** Antacids, such as [[Maalox]], [[Mylanta]], [http://wikidoc.org/index.php?title=Gelusil&action=edit&redlink=1 Gelusil], [[Rolaids]] and [[Tums]], can be used to neutralize stomach acid. Over-the-counter antacids.
** H-2-receptor blockers, such as [[cimetidine]], [[famotidine]], [[nizatidine]] or [[ranitidine]].
** [[Proton pump inhibitor]]s ([[PPI]]), such as [[lansoprazole]] and [[omeprazole]].
==Overview==
There is no treatment for [disease name]; the mainstay of therapy is supportive care.
 
OR
 
Supportive therapy for [disease name] includes [therapy 1], [therapy 2], and [therapy 3].
 
OR
 
The majority of cases of [disease name] are self-limited and require only supportive care.
 
OR
 
[Disease name] is a medical emergency and requires prompt treatment.
 
OR
 
The mainstay of treatment for [disease name] is [therapy].
 
OR
 
The optimal therapy for [malignancy name] depends on the stage at diagnosis.
 
OR
 
[Therapy] is recommended among all patients who develop [disease name].
 
OR
 
Pharmacologic medical therapy is recommended among patients with [disease subclass 1], [disease subclass 2], and [disease subclass 3].
 
OR
 
Pharmacologic medical therapies for [disease name] include (either) [therapy 1], [therapy 2], and/or [therapy 3].
 
OR
 
Empiric therapy for [disease name] depends on [disease factor 1] and [disease factor 2].
 
OR
 
Patients with [disease subclass 1] are treated with [therapy 1], whereas patients with [disease subclass 2] are treated with [therapy 2].
 
==Medical Therapy==
==Medical Therapy==
*Pharmacologic medical therapy is recommended among patients with [disease subclass 1], [disease subclass 2], and [disease subclass 3].
'''Sliding hiatus hernia'''
*Pharmacologic medical therapies for [disease name] include (either) [therapy 1], [therapy 2], and/or [therapy 3].
*Empiric therapy for [disease name] depends on [disease factor 1] and [disease factor 2].
*Patients with [disease subclass 1] are treated with [therapy 1], whereas patients with [disease subclass 2] are treated with [therapy 2].
===Disease Name===
 
* '''1 Stage 1 - Name of stage'''
** 1.1 '''Specific Organ system involved 1'''
*** 1.1.1 '''Adult'''
**** Preferred regimen (1): [[drug name]] 100 mg PO q12h for 10-21 days '''(Contraindications/specific instructions)''' 
**** Preferred regimen (2): [[drug name]] 500 mg PO q8h for 14-21 days
**** Preferred regimen (3): [[drug name]] 500 mg q12h for 14-21 days
**** Alternative regimen (1): [[drug name]] 500 mg PO q6h for 7–10 days 
**** Alternative regimen (2): [[drug name]] 500 mg PO q12h for 14–21 days
**** Alternative regimen (3): [[drug name]] 500 mg PO q6h for 14–21 days
*** 1.1.2 '''Pediatric'''
**** 1.1.2.1 (Specific population e.g. '''children < 8 years of age''')
***** Preferred regimen (1): [[drug name]] 50 mg/kg PO per day q8h (maximum, 500 mg per dose) 
***** Preferred regimen (2): [[drug name]] 30 mg/kg PO per day in 2 divided doses (maximum, 500 mg per dose)
***** Alternative regimen (1): [[drug name]]10 mg/kg PO q6h (maximum, 500 mg per day)
***** Alternative regimen (2): [[drug name]] 7.5 mg/kg PO q12h (maximum, 500 mg per dose)
***** Alternative regimen (3): [[drug name]] 12.5 mg/kg PO q6h (maximum, 500 mg per dose)
****1.1.2.2 (Specific population e.g. ''''''children < 8 years of age'''''')
***** Preferred regimen (1): [[drug name]] 4 mg/kg/day PO q12h（maximum, 100 mg per dose）
***** Alternative regimen (1): [[drug name]] 10 mg/kg PO q6h (maximum, 500 mg per day)
***** Alternative regimen (2): [[drug name]] 7.5 mg/kg PO q12h (maximum, 500 mg per dose) 
***** Alternative regimen (3): [[drug name]] 12.5 mg/kg PO q6h (maximum, 500 mg per dose)
** 1.2 '''Specific Organ system involved 2'''
*** 1.2.1 '''Adult'''
**** Preferred regimen (1): [[drug name]] 500 mg PO q8h
*** 1.2.2  '''Pediatric'''
**** Preferred regimen (1): [[drug name]] 50 mg/kg/day PO q8h (maximum, 500 mg per dose)


* 2 '''Stage 2 - Name of stage'''
Pharmacologic medical therapy is recommended among the patients with '''Sliding [[hiatus hernia]]''' when experince symptoms of gastroesophageal reflux disease (GERD) symptoms like:<ref name="pmid21927653">{{cite journal| author=Hyun JJ, Bak YT| title=Clinical significance of hiatal hernia. | journal=Gut Liver | year= 2011 | volume= 5 | issue= 3 | pages= 267-77 | pmid=21927653 | doi=10.5009/gnl.2011.5.3.267 | pmc=3166665 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21927653  }} </ref>
** 2.1 '''Specific Organ system involved 1 '''
* [[Nausea]]
**: '''Note (1):'''
* [[Vomiting]]
**: '''Note (2)''':
* [[Regurgitation]]
**: '''Note (3):'''
* [[Heart burn]]
*** 2.1.1 '''Adult'''
* [[Regurgitation]]
**** Parenteral regimen
* [[Dysphagia]]
***** Preferred regimen (1): [[drug name]] 2 g IV q24h for 14 (14–21) days
***** Alternative regimen (1): [[drug name]] 2 g IV q8h for 14 (14–21) days
***** Alternative regimen (2): [[drug name]] 18–24 MU/day IV q4h for 14 (14–21) days
**** Oral regimen
***** Preferred regimen (1): [[drug name]] 500 mg PO q8h for 14 (14–21) days
***** Preferred regimen (2): [[drug name]] 100 mg PO q12h for 14 (14–21) days
***** Preferred regimen (3): [[drug name]] 500 mg PO q12h for 14 (14–21) days
***** Alternative regimen (1): [[drug name]] 500 mg PO q6h for 7–10 days 
***** Alternative regimen (2): [[drug name]] 500 mg PO q12h for 14–21 days
***** Alternative regimen (3):[[drug name]] 500 mg PO q6h for 14–21 days
*** 2.1.2 '''Pediatric'''
**** Parenteral regimen
***** Preferred regimen (1): [[drug name]] 50–75 mg/kg IV q24h for 14 (14–21) days (maximum, 2 g)
***** Alternative regimen (1): [[drug name]] 150–200 mg/kg/day IV q6–8h for 14 (14–21) days (maximum, 6 g per day)
***** Alternative regimen (2):  [[drug name]] 200,000–400,000 U/kg/day IV q4h for 14 (14–21) days (maximum, 18–24 million U per day) ''''''(Contraindications/specific instructions)''''''
**** Oral regimen
***** Preferred regimen (1): [[drug name]] 50 mg/kg/day PO q8h for 14 (14–21) days  (maximum, 500 mg per dose)
***** Preferred regimen (2): [[drug name]] '''(for children aged ≥ 8 years)''' 4 mg/kg/day PO q12h for 14 (14–21) days (maximum, 100 mg per dose)
***** Preferred regimen (3): [[drug name]] 30 mg/kg/day PO q12h for 14 (14–21) days  (maximum, 500 mg per dose)
***** Alternative regimen (1):  [[drug name]] 10 mg/kg PO q6h 7–10 days  (maximum, 500 mg per day)
***** Alternative regimen (2): [[drug name]] 7.5 mg/kg PO q12h for 14–21 days  (maximum, 500 mg per dose)
***** Alternative regimen (3): [[drug name]] 12.5 mg/kg PO q6h for 14–21 days  (maximum,500 mg per dose)
** 2.2  '<nowiki/>'''''Other Organ system involved 2''''''
**: '''Note (1):'''
**: '''Note (2)''':
**: '''Note (3):'''
*** 2.2.1 '''Adult'''
**** Parenteral regimen
***** Preferred regimen (1): [[drug name]] 2 g IV q24h for 14 (14–21) days
***** Alternative regimen (1): [[drug name]] 2 g IV q8h for 14 (14–21) days
***** Alternative regimen (2): [[drug name]] 18–24 MU/day IV q4h for 14 (14–21) days
**** Oral regimen
***** Preferred regimen (1): [[drug name]] 500 mg PO q8h for 14 (14–21) days
***** Preferred regimen (2): [[drug name]] 100 mg PO q12h for 14 (14–21) days
***** Preferred regimen (3): [[drug name]] 500 mg PO q12h for 14 (14–21) days
***** Alternative regimen (1): [[drug name]] 500 mg PO q6h for 7–10 days 
***** Alternative regimen (2): [[drug name]] 500 mg PO q12h for 14–21 days
***** Alternative regimen (3):[[drug name]] 500 mg PO q6h for 14–21 days
*** 2.2.2 '''Pediatric'''
**** Parenteral regimen
***** Preferred regimen (1): [[drug name]] 50–75 mg/kg IV q24h for 14 (14–21) days (maximum, 2 g)
***** Alternative regimen (1): [[drug name]] 150–200 mg/kg/day IV q6–8h for 14 (14–21) days (maximum, 6 g per day)
***** Alternative regimen (2):  [[drug name]] 200,000–400,000 U/kg/day IV q4h for 14 (14–21) days (maximum, 18–24 million U per day)
**** Oral regimen
***** Preferred regimen (1):  [[drug name]] 50 mg/kg/day PO q8h for 14 (14–21) days  (maximum, 500 mg per dose)
***** Preferred regimen (2): [[drug name]] 4 mg/kg/day PO q12h for 14 (14–21) days (maximum, 100 mg per dose)
***** Preferred regimen (3): [[drug name]] 30 mg/kg/day PO q12h for 14 (14–21) days  (maximum, 500 mg per dose)
***** Alternative regimen (1):  [[drug name]] 10 mg/kg PO q6h 7–10 days  (maximum, 500 mg per day)
***** Alternative regimen (2): [[drug name]] 7.5 mg/kg PO q12h for 14–21 days  (maximum, 500 mg per dose)
***** Alternative regimen (3): [[drug name]] 12.5 mg/kg PO q6h for 14–21 days  (maximum,500 mg per dose)


===Lifestyle Modifications===
*The following measures are recommended as the first line to treat [[GERD]]:<ref name="pmid17573791">{{cite journal |author=Piesman M, Hwang I, Maydonovitch C, Wong RK |title=Nocturnal reflux episodes following the administration of a standardized meal. Does timing matter? |journal=Am. J. Gastroenterol. |volume=102 |issue=10 |pages=2128–34 |year=2007 |pmid=17573791 |doi=10.1111/j.1572-0241.2007.01348.x}}</ref><ref name="pmid16682569">{{cite journal |author=Kaltenbach T, Crockett S, Gerson LB |title=Are lifestyle measures effective in patients with gastroesophageal reflux disease? An evidence-based approach |journal=Arch. Intern. Med. |volume=166 |issue=9 |pages=965–71 |year=2006 |pmid=16682569 |doi=10.1001/archinte.166.9.965}}</ref>
**[[Weight loss]]
**Elevating head of the bed
**No eating two hours before going sleep
*Avoidance of the following foods and lifestyles is recommended in treatment of [[GERD]]:
**[[Coffee]]
**[[Alcohol]]
**Excessive amounts of [[Vitamin C]] supplements
**Foods high in fats
**[[tobacco smoking|Smoking]]
**Eating shortly before bedtime
**Large meals
**[[Chocolate]] and [[peppermint]].
**[[Acid]]ic foods, such as oranges and tomatoes.
**[[Cruciferous vegetables]] such as: Onions, cabbage, cauliflower, broccoli, spinach, brussel sprouts
**[[Milk]] and milk-based products
**Medical therapy<ref name="pmid21927653">{{cite journal |vauthors=Hyun JJ, Bak YT |title=Clinical significance of hiatal hernia |journal=Gut Liver |volume=5 |issue=3 |pages=267–77 |date=September 2011 |pmid=21927653 |pmc=3166665 |doi=10.5009/gnl.2011.5.3.267 |url=}}</ref><ref name="pmid21960816">{{cite journal |vauthors=Pandolfino JE |title=Hiatal hernia and the treatment of Acid-related disorders |journal=Gastroenterol Hepatol (N Y) |volume=3 |issue=2 |pages=92–4 |date=February 2007 |pmid=21960816 |pmc=3099358 |doi= |url=}}</ref>
*** '''[[Antacids]]''':<ref name="pmid1977703">{{cite journal |vauthors=Sontag SJ |title=The medical management of reflux esophagitis. Role of antacids and acid inhibition |journal=Gastroenterol. Clin. North Am. |volume=19 |issue=3 |pages=683–712 |year=1990 |pmid=1977703 |doi= |url=}}</ref><ref name="pmid219608162">{{cite journal |vauthors=Pandolfino JE |title=Hiatal hernia and the treatment of Acid-related disorders |journal=Gastroenterol Hepatol (N Y) |volume=3 |issue=2 |pages=92–4 |date=February 2007 |pmid=21960816 |pmc=3099358 |doi= |url=}}</ref>
**** Preferred regimen (1): [[Aluminum hydroxide]] 640 mg 5 to 6 times daily PO after meals and at bed time.
**** Preferred regimen (2): [[Calcium carbonate]] One gram PO.
*** '''[[Histamine-2 receptor blocker|Histamine-receptor antagonists]] (H2RA):'''<ref name="pmid12753150">{{cite journal |vauthors=Komazawa Y, Adachi K, Mihara T, Ono M, Kawamura A, Fujishiro H, Kinoshita Y |title=Tolerance to famotidine and ranitidine treatment after 14 days of administration in healthy subjects without Helicobacter pylori infection |journal=J. Gastroenterol. Hepatol. |volume=18 |issue=6 |pages=678–82 |year=2003 |pmid=12753150 |doi= |url=}}</ref>
**** Preferred regimen (1): [[Ranitidine]] 150 mg q12 daily PO
**** Preferred regimen (2): [[Cimetidine]] 400 mg q6h or 800 mg q12 PO for 12 weeks
**** Preferred regimen (3): [[Famotidine]] 20 mg q12 PO for 6 weeks
*** '''[[Proton pump inhibitors]]:'''<ref name="pmid11677201">{{cite journal |vauthors=Inadomi JM, Jamal R, Murata GH, Hoffman RM, Lavezo LA, Vigil JM, Swanson KM, Sonnenberg A |title=Step-down management of gastroesophageal reflux disease |journal=Gastroenterology |volume=121 |issue=5 |pages=1095–100 |year=2001 |pmid=11677201 |doi= |url=}}</ref><ref name="pmid14499769">{{cite journal |vauthors=Inadomi JM, McIntyre L, Bernard L, Fendrick AM |title=Step-down from multiple- to single-dose proton pump inhibitors (PPIs): a prospective study of patients with heartburn or acid regurgitation completely relieved with PPIs |journal=Am. J. Gastroenterol. |volume=98 |issue=9 |pages=1940–4 |year=2003 |pmid=14499769 |doi=10.1111/j.1572-0241.2003.07665.x |url=}}</ref>
**** Preferred regimen (1): [[Omeprazole]] 20 mg q24 PO for up to 4 weeks
**** Preferred regimen (2): [[Esomeprazole]] 20 mg or 40 mg q24 IV
*** '''[[Prokinetic|Prokinetic medications]]:'''
**** Preferred regimen (1): [[Metoclopramide]] 10 mg q24 PO for 4 to 12 weeks
'''Paraesophageal hernia''' 
* Pharmacologic medical therapies for Paraesophageal hernia [[asymptomatic]] patients remain always  controversial.<ref name="pmid18790148">{{cite journal |vauthors=Davis SS |title=Current controversies in paraesophageal hernia repair |journal=Surg. Clin. North Am. |volume=88 |issue=5 |pages=959–78, vi |year=2008 |pmid=18790148 |doi=10.1016/j.suc.2008.05.005 |url=}}</ref>


==References==
==References==


{{Reflist|2}}
{{Reflist|2}}
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[[Category:Up-To-Date]]
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[[Category:Primary care]]

Latest revision as of 22:10, 29 July 2020

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Vamsikrishna Gunnam M.B.B.S [2]

Overview

In most cases, patients experience no discomfort and no treatment is required. However, when a hiatal hernia is large, it is likely to cause esophageal stricture which results in discomfort. Symptomatic patients benefit from not lying down immediately after meals and also benefit by elevating the head of their beds. If stress has been idetified as the major riskfactor, stress reduction techniques may be practiced, or if overweight, weight loss may be indicated. Certain medications causes lower esophageal sphincter (or LES to relax those medications should be avoided. Anti-acid drugs like proton pump inhibitors and H2 receptor blockers can be used to decrease the acid secretion.

Medical Therapy

Sliding hiatus hernia

Pharmacologic medical therapy is recommended among the patients with Sliding hiatus hernia when experince symptoms of gastroesophageal reflux disease (GERD) symptoms like:[1]

Lifestyle Modifications

Paraesophageal hernia 

  • Pharmacologic medical therapies for Paraesophageal hernia asymptomatic patients remain always  controversial.[10]

References

  1. ↑ 1.0 1.1 Hyun JJ, Bak YT (2011). "Clinical significance of hiatal hernia". Gut Liver. 5 (3): 267–77. doi:10.5009/gnl.2011.5.3.267. PMC 3166665. PMID 21927653.
  2. ↑ Piesman M, Hwang I, Maydonovitch C, Wong RK (2007). "Nocturnal reflux episodes following the administration of a standardized meal. Does timing matter?". Am. J. Gastroenterol. 102 (10): 2128–34. doi:10.1111/j.1572-0241.2007.01348.x. PMID 17573791.
  3. ↑ Kaltenbach T, Crockett S, Gerson LB (2006). "Are lifestyle measures effective in patients with gastroesophageal reflux disease? An evidence-based approach". Arch. Intern. Med. 166 (9): 965–71. doi:10.1001/archinte.166.9.965. PMID 16682569.
  4. ↑ Pandolfino JE (February 2007). "Hiatal hernia and the treatment of Acid-related disorders". Gastroenterol Hepatol (N Y). 3 (2): 92–4. PMC 3099358. PMID 21960816.
  5. ↑ Sontag SJ (1990). "The medical management of reflux esophagitis. Role of antacids and acid inhibition". Gastroenterol. Clin. North Am. 19 (3): 683–712. PMID 1977703.
  6. ↑ Pandolfino JE (February 2007). "Hiatal hernia and the treatment of Acid-related disorders". Gastroenterol Hepatol (N Y). 3 (2): 92–4. PMC 3099358. PMID 21960816.
  7. ↑ Komazawa Y, Adachi K, Mihara T, Ono M, Kawamura A, Fujishiro H, Kinoshita Y (2003). "Tolerance to famotidine and ranitidine treatment after 14 days of administration in healthy subjects without Helicobacter pylori infection". J. Gastroenterol. Hepatol. 18 (6): 678–82. PMID 12753150.
  8. ↑ Inadomi JM, Jamal R, Murata GH, Hoffman RM, Lavezo LA, Vigil JM, Swanson KM, Sonnenberg A (2001). "Step-down management of gastroesophageal reflux disease". Gastroenterology. 121 (5): 1095–100. PMID 11677201.
  9. ↑ Inadomi JM, McIntyre L, Bernard L, Fendrick AM (2003). "Step-down from multiple- to single-dose proton pump inhibitors (PPIs): a prospective study of patients with heartburn or acid regurgitation completely relieved with PPIs". Am. J. Gastroenterol. 98 (9): 1940–4. doi:10.1111/j.1572-0241.2003.07665.x. PMID 14499769.
  10. ↑ Davis SS (2008). "Current controversies in paraesophageal hernia repair". Surg. Clin. North Am. 88 (5): 959–78, vi. doi:10.1016/j.suc.2008.05.005. PMID 18790148.
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