Diagnosis and treatment of hemorrhage in patients with hiatal hernia

Thirty two of 110 patients with symptomatic hiatal hernia had significant bleeding of the upper gastrointestinal tract. Endoscopy was useful to preoperatively diagnose the source of bleeding in 29 patients. It was found that 10 patients had bleeding from prepyloric or duodenal ulcers, and 22 patients had bleeding from either esophageal or gastric lesions associated with hiatal hernia. Medical treatment should be tried and is usually successful if there is an esophageal lesion. A specific diagnosis is necessary to provide optimal treatment. Twenty patients had erosive esophagitis or gastritis, and hernia repair alone was effective treatment. However, in 12 of 32 patients (38%) an ulcer was present and hernia repair alone would have been inadequate therapy. Four of the 6 patients who required an emergency operation had an ulcer.