More rarely, a part of the stomach enters the chest by sliding along the esophagus, the cardia remains in its normal position under the diaphragm, the abdominal cavity: the rolling hiatus hernia.
This anatomical abnormality may be intermittent or permanent. It may be easier and makes more particularly the prolonged reflux of acid from the stomach into the esophagus.



What are its causes?
They remain unknown. But predisposing factors can sometimes be found, such as obesity, which increases the pressure in the abdomen, a congenital shortening of the esophagus, trauma. . .

What are its signs?
The symptom most often a hiatal hernia is the gastro-esophageal reflux, typically favored by lying down or bending forward and occurring mainly after meals. Chest pain (sometimes simulating angina pectoris), shortness of breath, or twisting of the herniated stomach ( “volvulus” stomach requiring urgent treatment) are also possible. But most often, a hiatal hernia does no symptoms.

How is it diagnosed?
The defect can sometimes be observed on a simple chest radiography, but the diagnosis is usually made at endoscopy gastric-oso.

What is his salary?
No treatment is necessary in the absence of symptoms or complications. In case of gastro-esophageal reflux, of lifestyle advice is to follow (do not lie down immediately after meals, meal volume reasonable reduction overweight, no tight clothing on the abdomen, no tobacco or drug favoring reflux) but their effectiveness is reduced.
Medical treatment may also be indicated (anti-acids in cases of acrimony, prokinetic agents to facilitate the emptying of the stomach, and particularly anti-secretory gastric acids (inhibitors of proton pump “) if symptoms of frequent or associated with esophagitis.
In the absence of relief of regurgitation by medical treatment or mechanical complication of hernia surgery can be proposed. It involves replacing the stomach in the abdomen and produce an anti-reflux winding and setting the gastric fundus ( “air pocket”) around the lower end of the esophagus. This intervention can be made by colioscopie. Its results may deteriorate with time.