Diagnosis and treatment of hemorrhage in patients with hiatal hernia.

A retrospective study examined the clinical course of 32 patients with hiatal hernia in whom hemorrhage of the upper gastrointestinal tract was a prominent symptom. Hemorrhagic esophagitis was the most common source of bleeding. Duodenal ulcer, gastritis, and gastric ulcer of the herniated stomach were other less frequent causes of hemorrhage in these patients. Hemorrhage from esophagitis is usually mild and chronically recurrent. Surgical correction of the hiatal hernia and reflux is adequate treatment for the patient with hemorrhage from esophagitis or gastritis of the herniated stomach. Hemorrhage from duodenal ulcer as well as gastric ulcer requires a procedure directed at these lesions. Because of the association of upper gastrointestinal bleeding in hiatal hernia with lesions other than esophagitis, a vigorous diagnostic approach with endoscopy is essential.