Gastric Ulceration Within Hiatus Hernia

A retrospective analysis has been made of 19 persons with gastric ulceration in hiatus hernias. Eleven patients presented with acute upper gastrointestinal haemorrhage and three with chronic anaemia. Seventeen had experienced previous abdominal discomfort or heartburn. Diagnosis of ulceration was achieved by endoscopy in 16 instances and by radiography in six instances. A chronic ulcer was found in 10 patients, a discrete acute ulcer in three and multiple erosions in six. Twelve of the hernias were sliding in type and irreducible, in contrast to previous reports that gastric ulceration is most frequent in paracoesophageal hernias. Conservative management resulted in complete healing of the ulcer in the majority of patients. Continued bleeding or failure of the ulcer to heal necessitated surgical intervention in six patients.