Describe the management of patients with sliding hiatal hernia.
Conservative management
Lifestyle modifications
Proton pump inhibitors (PPIs) or histamine H2-receptor antagonists if symptoms of GERD occur
Surgery: laparoscopic/open fundoplication and hiatoplasty [2]
Indications
Persistence of symptoms despite conservative management
Refusal or inability to take long-term PPIs
Severe symptoms/complications of gastroesophageal reflux disease: bleeding, strictures, ulcerations
Describe the management of patients with types II, III, IV hiatal hernias.
Conservative management: older patients or those with other comorbidities [7]
Surgery: laparoscopic/open herniotomy + fundoplication, hiatoplasty, and gastropexy/fundopexy
Asymptomatic, small hernias in patients < 50 years of age
Symptomatic type II, III, IV hernias
What are complications of type I hernias?
Arise from long-standing gastroesophageal reflux
What are complications of type II, III, IV hernias?
Upper gastrointestinal bleeding (occult/massive) → iron deficiency anemia [8]
Gastric ulcers
Gastric perforation
Gastric volvulus [2]
A rare condition characterized by abnormal rotation of the stomach
Can occur in the abdomen or chest (upside-down stomach)
Classified according to the rotational axis: organoaxial (around the long axis of the stomach) and mesenteroaxial (between the lesser and greater curvature)
Total gastric obstruction
The complications of types II, III, and IV are often medical emergencies.
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