# Hiatus Hernia - Category: chronic - Review status: reviewed (every claim checked against a document named on this page) - Sources: Egyptian National Drug Formulary - Gastrointestinal Tract 2025 · ACG Management of GERD 2022 · Hiatal Hernia - StatPearls, Puri & Sharma, updated 31 January 2026 - https://www.ncbi.nlm.nih.gov/books/NBK562200/ - Verified date: 2026-08 ## Verified against - Egyptian National Drug Formulary - Gastrointestinal Tract 2025 - ACG Management of GERD 2022 - Hiatal Hernia - StatPearls, Puri & Sharma, updated 31 January 2026 - https://www.ncbi.nlm.nih.gov/books/NBK562200/ - Hiatal Hernia - disease-level clinical article (hiatus-hernia-clinical.txt) ## Treatment metadata - Omeprazole — 20 mg — oral.solid - Referral & safety-netting (no drug therapy) ## Complete treatment card ```text HIATUS HERNIA Sources: Egyptian National Drug Formulary - Gastrointestinal Tract 2025 · ACG Management of GERD 2022 · Hiatal Hernia - StatPearls, Puri & Sharma, updated 31 January 2026 - https://www.ncbi.nlm.nih.gov/books/NBK562200/ Review status: REVIEWED against Egyptian National Drug Formulary - Gastrointestinal Tract 2025, ACG Management of GERD 2022, Hiatal Hernia - StatPearls, Puri & Sharma, updated 31 January 2026 - https://www.ncbi.nlm.nih.gov/books/NBK562200/, Hiatal Hernia - disease-level clinical article (hiatus-hernia-clinical.txt) (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (8) - Heartburn and regurgitation are the typical features of GERD, which often prompts evaluation for a hiatal hernia [heartburn · hernia · regurgitation] - Some patients instead report atypical symptoms such as a chronic cough, hoarseness, or asthma [cough · hoarseness] - Regurgitation and symptoms outside the gut usually mean the disease has progressed further [regurgitation] - Severe regurgitation can prevent lying flat, so the degree of head-of-bed elevation needed is a simple gauge of its severity [regurgitation] - Choking can occur from breathing in refluxed stomach contents - Undigested food in vomit points away from simple reflux toward achalasia or a Zenker diverticulum [diverticulosis · heartburn] - Difficulty swallowing is common with large hiatal hernias that mechanically obstruct the gullet [difficulty swallowing] - Breathlessness occurs in 30 to 44 percent of cases with a large hiatal hernia before surgery [breathlessness · hernia] SIGNS - what you find (2) - Physical examination on its own rarely confirms hiatal hernia or GERD [hernia] - Swollen lymph nodes above the collarbone in a patient with heartburn and swallowing trouble raise concern for oesophageal or stomach cancer [heartburn · lymphadenopathy] TESTS (10) - A barium swallow and upper endoscopy are the two essential tests for every patient with a hiatal hernia - Barium swallow is the gold-standard test for measuring hiatal hernia size - In achalasia, the barium study shows a widened gullet that narrows smoothly at the lower sphincter - Endoscopy grades erosive oesophagitis on the Los Angeles scale, and grade B, C, or D confirms GERD - Biopsy-proven Barrett oesophagus or a peptic stricture counts as objective proof of GERD - A 48-hour pH study done off medication is the gold standard for confirming acid reflux - A DeMeester score of 14.7 or higher indicates significant reflux - An acid exposure time above 6% over 24 hours, or over 48 hours on the wireless test, is diagnostic of GERD - High-resolution manometry rules out achalasia and other motility disorders before surgery is planned - Finding a large hiatal hernia on endoscopy should prompt a barium swallow to size it accurately IF NOT THIS - what else fits (5) - Typical heartburn is a burning sensation in the upper abdomen rather than a radiating pressure, a clue that separates it from cardiac pain - A careful history separates GERD from four mimics: pancreatitis, biliary disease, peptic ulcer disease, and acute coronary syndrome - Reflux hypersensitivity or functional heartburn can mimic typical GERD symptoms - Swallowing trouble from a large hernia must be told apart from a peptic stricture, oesophageal cancer, a diverticulum, or achalasia - Symptoms outside the gullet, such as throat or lung complaints, require weighing a primary motility disorder, gastric or oesophageal cancer, and primary lung disease Source StatPearls "Hiatal Hernia" - disease-level clinical article Status traced to the source above 1. OMEPRAZOLE [1st line] Adult 20 mg once daily in the morning before food x 8 weeks, then reassess Peds Licensed in children over 1 year at 10-20 mg daily under specialist care. A hiatus hernia found in a child is a paediatric surgical question, not a prescription. Source Egyptian National Drug Formulary - Gastrointestinal Tract 2025 (omeprazole monograph): "Gastroesophageal reflux disease, including reflux esophagitis - Oral: 10-20 mg once daily. Up to 40 mg once daily in refractory cases. Duration: 4-8 weeks." The paediatric statement shown here is not from this formulary, whose only paediatric omeprazole line is 0.7-1.4 mg/kg in children over 2 years for severe ulcerating esophagitis. The ACG GERD guideline is not held in this corpus. Why Most hiatus hernias are asymptomatic and need nothing. When they cause reflux symptoms the treatment is the reflux treatment: the article's recommendation is a proton pump inhibitor once a day, taken in the morning before food, over a course of 8 weeks. The dose is the sourced omeprazole dose for reflux. Caution MOST ARE ASYMPTOMATIC AND NEED NO TREATMENT. StatPearls: 55-60% of people over 50 have one, and symptoms appear in about 10% of them at most. Finding one on a scan is not a reason to start a drug. Dysphagia, vomiting, weight loss, anaemia or chest pain are not to be treated with a PPI and reviewed in two months - they need endoscopy. A large paraesophageal (type II-IV) hernia can strangulate. Sudden severe chest or epigastric pain with retching and inability to vomit is a surgical emergency. Surgery is for a mechanically defective sphincter, failure of PPI, severe erosive oesophagitis, or a symptomatic large paraesophageal hernia - not for the hernia's existence. Long-term PPI is not free of cost: review the need at every repeat rather than continuing it by default. Egypt OMEGASTAZOLE 20MG 14 CAPS. RIVA PHARMA S... 18.00 EGP (1.29/unit) OMEPRAL 20MG 14 CAPS. MEMPHIS 32.00 EGP (2.29/unit) RISEK 20 MG 28 CAPS. JULPHAR 75.00 EGP (2.68/unit) OMISEC 20MG 14CAPS. THE UNITED PH... 42.00 EGP (3.00/unit) EPIRAZOLE 20MG 14CAPS. EIPICO 44.00 EGP (3.14/unit) OMEPAK 20 MG 14 CAPS. SEDICO 50.00 EGP (3.57/unit) RISEK 20 MG 14 CAPS. JULPHAR 57.00 EGP (4.07/unit) NAPIZOLE 20MG 14 CAPS. GLOBAL NAPI P... 62.00 EGP (4.43/unit) 2. REFERRAL & SAFETY-NETTING (NO DRUG THERAPY) [1st line] Adult Source Hiatal Hernia - disease-level clinical article (hiatus-hernia-clinical.txt) Why Carries the referral criteria and warning signs for this condition, which apply whichever treatment is chosen. Caution RED FLAG - An incarcerated paraesophageal hernia or gastric volvulus presents with acute nausea, vomiting, and chest pain, and requires immediate decompression and urgent repair. Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)