Hiatus hernia is treated by-a) Surgery when medical treatment has failedb) Nissens' fundoplicationc) Medical treatment onlyd) None of the above

• Greater than 95% of HHs is type I or sliding hernias • Of all PEHs, type III is the most common • PEHs are more common in females and have an autosomal dominant mode of transmission. • MC structure to herniate is the fundus of the stomach; other structures that may be located in the hernia sac include the spleen, colon, and omentum • Type IV PEH has a higher incidence of serious results, with 50% of patients presenting emergently. Clinical Features • Most common preoperative symptom and finding is the typical heatburn • Others are chest pain, epigastric pain, dysphagia, postprandial fullness, regurgitation, vomiting, weight loss, anemia, and respiratory symptoms. • Hematemesis or anemia is evident in about a third of patients with PEH. Diagnosis • Barium swallow is the most important diagnostic test. • Endoscopy helps to identify mucosal erosions as a source of gastrointestinal blood loss. • Manometry is needed to determine the motor function of the esophageal body. Treatment • Surgical approach: Transabdominal (laparoscopic or open) or transthoracic. • Transabdominal laparoscopic approach for HH repair is preferred Cameron Ulcer or Riding Ulcer • Bleeding can be caused by ischemia of the gastric mucosa or by riding ulcers or Cameron’s ulcers. • Cameron’s ulcers are due to the constant abrasive force as the stomach rubs against or is pinched by the diaphragmatic hiatus. • The continuous movement of the stomach and esophagus as they travel up and down with respiration and swallowing compounds the problem. • Anemia from a PEH resolves in 92% of patients after surgical repair.