Hiatal Hernia 
hiatal hernia is the herniation of the stomach into the chest cavity through the diaphragmatic esophageal hiatus.
Rarely congenital type, the etiology of hiatal hernias has multiple causes, and are cited including the decreased elasticity and tone of the structures that attach the esophagus-stomach to the diaphragm and increased intra-abdominal pressure.
The prevalence varies considerably, depending on the study, you can get up to 60% of older people affected. In a series of 220 institutionalized elderly have been reviewed, in 20% of them among his antecedents hiatal hernia.
retrosternal heartburn, epigastric pain, and / or chest, bloating, fullness and gastrointestinal bleeding, usually by small blood loss are common symptoms . In many cases the disease no symptoms and is an incidental finding in the study of other pathologies. Alcohol, snuff, obesity, difficulty in chewing, large meals, carbonated drinks and those situations that increase intraabdominal pressure trigger or worsen symptoms .
The diagnosis is made by radiological study with barium contrast in the esophagus-stomach. With a progressive increase in its use, the endoscope broad and comprehensive study of this disease. In plain chest radiographs and CT and MRI thoracoabdominal can also be seen hiatal hernias.
The differential diagnosis be done with heart disease (angina, myocardial infarction, pericarditis), respiratory (pneumonia, pleural effusion, pulmonary embolism and pathology of the mediastinum), digestive (esfofágicas other injuries, gastric, hepatobiliary disease) and psychological.
Add to hygienic-dietary measures (elevation of head of bed 8-10 cm, avoiding snuff, alcohol, fizzy soft drinks and medicines, making frequent meals of small amounts chewing food properly, preventing constipation to avoid an increase in intra-abdominal pressure), prescription inhibitors, proton pump, omeprazole primarily, is the most common treatment. Antacids, prokinetics and surgical treatments are also used less frequently.
The image exposed for the occasional finding, a preoperative study performed on a 85 year old male was going to have an operation for prostate adenoma, an image of lower mediastinum hyperlucency , marked with a circle, corresponds to a hiatal hernia. The old man meant never having had gastrointestinal symptoms.
