Gastroesophageal Conditions:  Hiatal Hernia, GERD, & Barrett’s Esophagus

Hiatal Hernia

• Definition: Part of the stomach protrudes into the thoracic cavity through the hiatus (opening in the diaphragm).
• Types:
  • Sliding hiatal hernia: The gastroesophageal junction and part of the stomach slide up into the thoracic cavity, especially when lying down.
  • Para-esophageal hernia: Part of the stomach forms a sac beside the esophagus and may get trapped.
• Causes: Weakness in the diaphragm, increased abdominal pressure (e.g., pregnancy).
• Consequences: Acid reflux into the esophagus, leading to damage.
• Management: Avoid lying down immediately after eating, smaller meals, surgical correction if severe.

Gastroesophageal Reflux Disease (GERD)

• Definition: Acid reflux into the esophagus causing heartburn.
• Cause: Weak lower esophageal sphincter (LES) or excess acid.
• Symptoms: Heartburn (30-60 min after eating), cough, chest pain.
• Risks: Damage to esophageal lining (erosion, fibrosis, strictures).
• Complication: Barrett’s esophagus (metaplasia) — replacement of squamous cells with columnar cells, increasing cancer risk.

Diagnosis

• Imaging: Barium swallow, endoscopy.
• pH Monitoring: Detects acid levels in the esophagus.
• Manometry: Measures LES pressure.

Treatment

• Lifestyle:
  • Small, frequent meals.
  • Avoid caffeine, alcohol, spicy, fatty foods.
  • Do not lie down after meals.
  • Quit smoking.
• Pharmacologic:
  • Antacids.
  • Histamine receptor blockers.
  • Proton pump inhibitors (PPIs).
• Surgical:
  • Fundoplication to strengthen LES.

Barrett’s Esophagus

• Metaplasia: Stratified squamous epithelium replaced with simple columnar epithelium.
• Risks: Precancerous, potential progression to dysplasia and esophageal adenocarcinoma.
• Prevalence: 800,000 Canadians affected; half are unaware.
• Management: Acid suppression, regular surveillance, lifestyle modifications.

Visuals

• Normal vs. damaged esophagus.
• Damage from chronic reflux shows metaplasia and inflammation.
• Prevention: Healthy weight, smaller meals, avoiding irritants, stopping smoking.