Esophageal Varices and Hiatus Hernia (3 of 3 )

Aside from de hiatus hernia the patient presents with esofageal varices No clear correlation exists between the size of a hiatal hernia and the severity of the symptoms. A very large hiatal hernia may be present with no symptoms at all. Some complications are specific for a hiatal hernia. Esophageal complications By far, the majority of hiatal hernias are asymptomatic. Often, patients are left with the impression that they have a disease when a hiatal hernia is diagnosed. In rare cases, however, a hiatal hernia may be responsible for intermittent bleeding from associated esophagitis, erosions (Cameron ulcers), or a discrete esophageal ulcer, leading to iron-deficiency anemia. The prevalence of large hiatal hernias in patients with iron deficiency anemia is 6-7%. This particular complication is more likely in patients who are bed-bound or those who take nonsteroidal anti-inflammatory drugs. Massive bleeding is rare. Nonesophageal complications Incarceration of a hiatal hernia is rare and is observed only with paraesophageal hernia. When this occurs, it can present abruptly, with a sudden onset of vomiting and pain, sometimes requiring immediate operative intervention.