DEFINITION

The thorax is separated from the abdomen by a flat muscle called diaphragm. The digestive pipe enters the abdomen across a hole, or hiatus, of the diaphragm. A hiatus rupture is the situation that happens when a part of the stomach gets in the cavity of the thorax across the hiatus of the diaphragm, producing thoracic pain and ardors.

CAUSES, INCIDENCE AND FACTORS OF RISK

The hiatus rupture is very frequent, especially in the people> of 50 years. The cause is not known but it can be a result of a weakening of the textiles. The obesity and the nicotinism can be risk factors.

CLINICAL SYMPTOMS

• ardor of stomach, which deteriorates on having lain down or having stooped.
• thoracic pain
• make difficult to swallow
• palpitations

There can be no symptom.

DIAGNOSIS

Physical examination. It is usually normal.

X-ray studies. The abdomen radiographies with contrast demonstrate the hiatus hernia.

Studies endoscópicos. The digestive endoscopia (direct observation of the esophagus and stomach with a flexible optical fibre pipe) helps to discard other causes of high digestive inconveniences.

TREATMENT

Conservative treatment. In the beginning, the acid regurgitation will try to diminish towards the esophagus (ebb gastroesofágico), for what it is useful:

• medications that neutralize the acidity of the stomach.
• to avoid very copious meals.
• not to lie down or to stoop just after a meal.
• to stop smoking and reducing weight.

Surgical treatment. It appears when it trumps the previous thing or before the presence of complications.

In general, the hiatus ruptures are carried very well with conservative treatment. Nevertheless, serious complications can happen:

• anemia for slow blood losses of the stomach, and supported, and inadvertent.
• aspiration of the gastric content for the lungs.
• strangulation of the rupture with necrosis of the digestive pipe.

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