Hiatus hernia and gastro-oesophageal reflux disease

Gastro-oesophageal reflux disease (GORD) is a common condition with a prevalence of 10–25% in Europe and a rising prevalence in developing nations. GORD is typified by the symptomatic passage of gastric contents into the oesophagus with or without mucosal injury. Hiatus hernias usually contribute to the pathophysiology of GORD and the presence of an ‘acid pocket’ can worsen symptom severity. Rather than a spectrum of disease progression, GORD is best considered as a group of related syndromes: endoscopy-negative disease, oesophagitis (with or without complications, such as strictures), Barrett's oesophagus and oesophageal adenocarcinoma. While a ‘classical’ presentation with retrosternal discomfort, volume reflux or mild odynophagia is common, it is important to recognize extra-oesophageal manifestations of the disease, especially respiratory and laryngeal symptoms. The mainstay of management is symptom control through lifestyle modification and acid suppression therapy. However, in selected patients, anti-reflux surgery may be indicated, and novel medical and surgical treatments are being actively researched.