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Virtual Pediatric Hospital: Paediapaedia: Hiatal Hernia and Gastroesophageal Reflux (HH / GER) Paediapaedia: Gastrointestinal Diseases

Hiatal Hernia and Gastroesophageal Reflux (HH / GER)

Michael P. D'Alessandro, M.D.
Peer Review Status: Internally Peer Reviewed


Clinical Presentation:
Symptoms are due to reflux present from birth and peptic esophagitis such as pain, dysphagia and hematemesis. Sandifer's syndrome consists of torsional spasms of the head, neck and upper extremities in older children probably related to unconscious efforts to reduce the hernia.

Etiology/Pathophysiology:
The hiatal hernia and accompanying shortened esophagus are probably caused by reflux esophagitis and cicatrical traction on the gastroesophageal junction and stomach.. In kids most hiatal hernias are the sliding type with variable amounts of stomach passing through the esophageal hiatus into the chest. This impairs the competency of the gastroesophageal sphincter, producing gastroesophageal reflux. A paraesophageal hernia is one in which part of greater curvature of the stomach passes through the hiatus beside a normally placed gastroesophageal junction. Complications seen in a hiatal hernia include aspiration pneumonia and peptic esophagitis with stricture.

Pathology:
Not applicable

Imaging Findings:
On abdominal plain films, large hernias are seen as retrocardiac densities or lucencies that may have air fluid levels.

Upper GI can show reflux and the variable degrees of gastric herniation, esophagitis, and esophageal strictures.

DDX:

References:
See References Chapter.

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