Digestive Surgery & Gastroenterology & Family Medicine & Thoracic Surgery
Hiatal hernia
Hiatal hernia is the passage of a portion of the stomach - and sometimes other abdominal organs - into the thorax through the esophageal hiatus of the diaphragm, an opening normally crossed only by the esophagus, vagus nerves and gastro-phrenic vessels. It is one of the most frequent digestive anatomical anomalies: its radiological prevalence reaches 20-60 % of the adult population, depending on the criteria used and the method of detection, increasing sharply with age and obesity. The vast majority of hiatal hernias are asymptomatic, discovered incidentally during digestive investigations for other indications. The most frequent form (95 % of cases) is the sliding hiatal hernia (type I), in which the oesogastric junction migrates above the diaphragm - promoting gastro-oesophageal reflux disease (GERD) through impaired anti-reflux mechanisms. Paraesophageal hernias (types II, III, IV) are much less frequent but more dangerous: the risk of volvulus, strangulation or gastric necrosis makes them potentially urgent surgical indications. Symptomatic management of sliding hiatal hernia relies mainly on proton pump inhibitors (PPIs) and anti-reflux hygienic and dietary measures. Surgery (laparoscopic Nissen or Toupet fundoplication) is reserved for PPI-refractory and bulky forms, and for all symptomatic paraesophageal hernias.
Anatomy, classification, and pathophysiology
- Anatomy of the esophageal hiatus and normal anti-reflux mechanisms: normal esophageal hiatus: elliptical opening in the diaphragm → crossed by distal esophagus + vagus nerves + left gastric artery ascending branch → phreno-esophageal ligament (membrane of Laimer-Bertelli): elastofibrous tissue → anchors the esogastric junction (JOG) 1-2 cm below the diaphragm → normal anti-reflux mechanisms: lower esophageal sphincter (LES): zone of high pressure (10-30 mmHg at rest) → 3-4 cm above the JOG → transient LES relaxation (TRSOR): main mechanism of physiological GERD → if abnormal frequency and amplitude → pathological GERD + His angle: acute angle between esophagus and greater gastric curvature → valve role → mechanical valve flap + intra-abdominal segment of esophagus: subjected to positive abdominal pressure → passive compression → anti-reflux role + right diaphragmatic pillars: extrinsic contraction on distal esophagus → external sphincter role → increased amplitude during coughing and abdominal efforts; pathophysiology of sliding hiatal hernia and GERD: migration of the JOG into the thorax → destruction or stretching of the phreno-oesophageal ligament → abolition of the intra-abdominal segment of the oesophagus → loss of the effect of the diaphragmatic pillars → modification of the His angle (obtuse angle → reduction of the valve) → prolonged exposure of the oesophageal mucosa to acid → increased frequency and duration of reflux → «acid trap» mechanism: the herniated gastric pouch accumulates acid and refluxes it back into the esophagus when the LES is released → from Mittal 1997 - Gut + Pandolfino 2003 - Gastroenterology : HH and GERD → hiatal hernia size correlates with GERD severity + Dent 1980 - Gastroenterology: role of the «acid pocket» in GERD associated with HH; anatomical classification (Rome IV + international guidelines): type I - sliding hiatal hernia: 95 % of cases + migration of the JOG above the diaphragm + posterior gastric wall remains in continuity with the intra-abdominal stomach + often small (<3 cm) + toujours associée à un rgo potentiel → type ii — hernie para-œsophagienne pure : rare (<5 % des hh) la jog reste en place le fundus gastrique passe travers hiatus côté de l'œsophage risque d'étranglement iii mixte (type i ii) et migrent grande volvulus iv géante migration d'autres organes abdominaux (côlon transverse intestin grêle rate queue du pancréas) très maximal complications classification par taille (en cm au-dessus hiatus) petite <3 modérée 3–5>5 cm
- Epidemiology, risk factors, and clinical presentation: Epidemiology: Global prevalence: 20–60 % depending on detection methods (radiological vs. endoscopic vs. manometric) → increases with age: <50 ans → 10–15 % +>70 years → 50-70 % → obesity (BMI >30): increases prevalence × 2-3 (elevated intra-abdominal pressure) → DeLegge 2008 - American Journal of Gastroenterology: obesity + sliding hiatal hernia → strong association + white race + female sex + multiple pregnancies → increase risk of paraesophageal hernia (hormonal ligament loosening); favoring factors: chronic increase in intra-abdominal pressure: obesity + chronic constipation + COPD with chronic cough + ascites + repeated pregnancies + heavy lifting + ageing: elastic degeneration of the phreno-oesophageal ligament + anterior oesophageal or gastric surgery + Marfan's syndrome + Ehlers-Danlos + other connective tissue diseases; clinical presentation according to type: sliding hernia (type I): GERD symptoms in 50-80 % of symptomatic patients: pyrosis (retrosternal burning) + acid regurgitation + aggravation in supine position + nocturnal + after meals + aggravation by anterior flexion (yaw sign) + chronic nocturnal cough + hoarseness + asthma + posterior laryngitis (extraoesophageal manifestations of GERD) + complications of chronic GERD: erosive esophagitis + peptic stenosis + endobrachyoesophagus (Barrett's esophagus) → precancerous → paraesophageal hernia (types II-IV): mechanical symptoms: dysphagia + early satiety + sensation of retrosternal blockage + chest pain + post-prandial vomiting + chronic iron-deficiency anemia (Cameron's ulcer: linear ulceration on the neck of the hernia - Cameron 1986 - Gastroenterology: Cameron's lesions → anemia in 14 % of large hiatal hernias) + much less often GERD (JOG is in place in pure types II) + acute complications: gastric volvulus + strangulation + necrosis → surgical emergency
Diagnosis, medical and surgical treatment
| Domain | Data, methods and criteria | Key studies and recommendations |
|---|---|---|
| Preoperative diagnosis and assessment TOGD - endoscopy - manometry - pH monitoring - chest X-ray - CT scan - pre-surgical workup - umbrella sign |
Diagnostic methods depending on clinical context: standard chest X-ray: can reveal a large hernia → retrocardiac opacity + retrosternal hydro-aeric level → diagnosis of a large hiatal hernia + umbrella sign (air in the hernia) → not sufficient for small hernias or characterization; oeso-gastro-duodenal transit (TOGD) - barium or water-soluble: historical reference technique for anatomical characterization of the hernia → visualizes the passage of the JOG over the hiatus + measures the size of the hernia + assesses reflux (not specific to this examination - caused by maneuvers) + detects complications (stenosis + volvulus) → indicated pre-operatively systematically for complex hernias → thoracoabdominal CT scan: pre-operative assessment of bulky hernias (types III-IV) → assesses herniated organs + anatomical relationships + detects complications + plans surgical approach; upper GI endoscopy (EOGD): visualizes the hernia directly (the JOG in the thorax on retrovision) + assesses hernial contents + screens for mucosal complications: erosive esophagitis + stenosis + endobrachyoesophagus (EB) + Cameron ulcer (linear ulcerations on the neck of the hernia - Cameron 1986 - Gastroenterology) + systematic EOGD before any hiatal hernia surgery. hiatal hernia → Los Angeles classification for erosive esophagitis (grades A-D) → biopsies if abnormal mucosa → screening for EB (Barrett's mucosa segments) → hernia size endoscopically : measurement of distance between diaphragmatic pinch and endoscopic JOG (normally 4.2 % of total time) → DeMeester score >14.72 → pathological GERD → impedancemetry-pH: detects non-acid and low-acid reflux + measures total number of refluxes + prognostic value of response to surgery → indispensable if GERD without esophagitis + if atypical symptoms + if failure of PPIs → complementary functional tests: gastric emptying scan: if delayed gastric emptying suspected → relative contraindication to fundoplication → Bravo test (wireless capsule pH-metry × 48h): less invasive than pH-metry catheter + better symptom-reflux correlation; Brodsky classification of surgical difficulty (pre-op): factors of technical difficulty: bulky hernia (type III-IV) + obesity + previous abdominal surgery + recurrent hernias + hypertrophic liver | Data on diagnostic methods: Dent 1980 - Gastroenterology: acid pocket + hiatal hernia → key mechanism of GERD associated with HH → founder of the acid trap concept + Pandolfino 2003 - Gastroenterology: HRM + hiatal hernia → hernia size correlates with LES pressure and GERD severity → Mittal 1997 - Gut: pathophysiological mechanisms of GERD associated with hiatal hernia → contribution of hernia to LES dysfunction + Cameron 1986 - Gastroenterology: Cameron ulcers → endoscopic discovery + anemia in 14 % of large hernias + treatment: PPI + or surgery + Yadlapati 2021 - Neurogastroenterology and Motility: Chicago Classification v4.0 → reference for manometry + classification of motor disorders + screening for achalasia before fundoplicature → indispensable pre-operatively + Katz 2013 - American Journal of Gastroenterology (ACG Guidelines): 24h pH-metry = gold standard for GERD diagnosis → pH 4.2 % of time + DeMeester >14.72 = pathological GERD + Shay 2004 - American Journal of Gastroenterology: impedancemetry-pH → detects non-acid reflux → improves diagnosis of atypical GERD vs ongoing PPI therapy |
| Medical treatment — sliding hiatal hernia and GERD IPP — H2 blockers — hygiene and dietary measures — alginate — antacids — PPI failure — Barrett's — surveillance |
Hygienic-dietary anti-reflux measures - basis of conservative treatment: raise the head of the bed (15-20 cm - not just pillows that bend the trunk) + don't lie down in the 2-3h post-prandial + weight reduction if obese (reduction in intra-abdominal pressure → reduction in GERD - Jacobson 2006 - NEJM: each additional unit of BMI → increase in GERD frequency by 35 %) + avoid trigger foods: alcohol + coffee + chocolate + peppermint + fats + spices + tomatoes + citrus fruits + avoid heavy meals + small, frequent portions + stop smoking (reduces LES pressure) + avoid tight-fitting clothes + reduce alcohol; proton pump inhibitors (PPIs) - reference pharmacological treatment for GERD on hiatal hernia: mechanism: irreversible inhibition of H⁺/K⁺-ATPase in gastric parietal cells → reduction of acid production by 90-95 % → 1st-generation PPIs: omeprazole + lansoprazole + pantoprazole + esomeprazole + rabeprazole → taken 30-60 min before meal (so that parietal cells are active during absorption) → standard dose: omeprazole 20 mg/d or equivalent → double dose if insufficient → Chiba 1997 - Gastroenterology (meta-analysis): PPIs superior to H₂-blockers for healing erosive esophagitis → healing at 8 weeks: PPI 83 % vs H₂ 52 % → PPI = reference treatment → Galmiche 2011 - JAMA (LOTUS RCT trial n=554): PPI × 5 years vs laparoscopic surgery (Nissen fundoplicature) in GERD → similar results at 5 years in terms of symptom control → fundoplicature slightly superior on acid exposure but more adverse effects (dysphagia + bloating + flatulence) → vonoprazan (potassium-based acid inhibitor - PCAB): superior to PPIs in some Japanese-Asian studies + awaiting full approval in Canada → Laine 2023 - NEJM: vonoprazan non-inferior to esomeprazole for cure of grade C-D erosive esophagitis → H₂-blockers (ranitidine withdrawn - famotidine - cimetidine): inferior to PPIs for esophagitis → useful as nocturnal adjunctive therapy (nocturnal PPI resistance) or as co-treatment if rebound symptoms on stopping PPIs → alginates (Gaviscon): formation of a floating raft over gastric contents → mechanical anti-reflux barrier → effective for mild post-prandial reflux → less effective than PPIs for esophagitis → antacids (calcium carbonate + magnesium hydroxide + aluminum): immediate symptomatic relief → no efficacy on esophagitis → on-demand use; monitoring and screening for endobrachyoesophagus (Barrett's esophagus - BE): chronic GERD + hiatal hernia + risk factors → risk of EB → screening by EOGD according to indications (ACG 2022 + CAG): chronic GERD (>5 years) + 2 additional risk factors among: male + ≥50 years + obesity + smoking + race white + family history of EB or esophageal adenocarcinoma → systematic biopsies of the suspect mucosa (Seattle protocol: 4-quadrant biopsies every 1-2 cm) → Barrett's surveillance according to dysplasia grade: EB without dysplasia: endoscopy + biopsies every 3-5 years → EB with low-grade dysplasia: treatment with radiofrequency ablation (RFA) or close surveillance → EB with high-grade dysplasia or superficial cancer: endoscopic resection (EMR + ESD) + RFA → Shaheen 2009 - NEJM (AIM Dysplasia Trial): RFA in dysplastic EB → eradication of dysplasia in 81 % + eradication of Barrett's in 77 % → reference treatment for dysplastic Barrett's. | Fundamental data on medical treatment: Chiba 1997 - Gastroenterology (meta-analysis 33 RCTs): PPI vs H₂-blockers → superior PPI → esophagitis cure: PPI 83 % vs H₂ 52 % → PPI = standard of care + Galmiche 2011 - JAMA (LOTUS trial RCT n=554): PPI × 5 years vs fundoplication × 5 years → similar results → fundoplication slightly superior on objective measure of acid exposure → but more surgical adverse effects (dysphagia + flatulence) + Jacobson 2006 - NEJM: each additional unit of BMI → +35 % GERD frequency → weight loss = key hygienic-dietary measure + Shaheen 2009 - NEJM (AIM Dysplasia Trial): RFA → dysplasia eradication 81 % + Barrett eradication 77 % → reference treatment for dysplastic EB + Laine 2023 - NEJM: vonoprazan vs esomeprazole → non-inferiority → vonoprazan emerging + Katz 2013 - ACG: GERD guidelines → empirical treatment with PPI if typical symptoms + endoscopy if red flags + pH-metry if diagnostic doubt + CAG 2023: Canadian adaptation of GERD recommendations + Barrett screening according to criteria. |
| Surgical Treatment — Fundoplication and Hiatal Hernia Repair Nissen fundoplication — Toupet — laparoscopy — outcomes — recurrence — indications — paraesophageal hernia — mesh |
Surgical indications: sliding hernia (type I) with GERD : GERD refractory to PPIs at optimal doses despite 3-6 months of treatment + GERD with complications (severe grade C-D esophagitis + Barrett's + recurrent peptic stenosis) + lifelong intolerance or refusal of PPIs + predominant regurgitation (PPIs control pyrosis but not always regurgitation) + dependence on PPIs in young patients + hernia volume correlated with risk of surgical recurrence + para-esophageal hernia (types II-III-IV) : surgical indication when hernia is symptomatic + or asymptomatic but voluminous (risk of volvulus) → controversy remains for asymptomatic paraesophageal hernias: Stylopoulos 2002 - Annals of Surgery: decision analysis → the risk of acute volvulus requiring emergency surgery is 1.1 %/year → NNT to prevent 1 emergency by operating on asymptomatic hernias: around 90 → most surgeons propose surgery if the hernia is large + the patient is in good operative condition + mechanical symptoms; laparoscopic fundoplicature - reference surgical technique: principle: reduction of the hernia contents in the abdomen + closure of the hiatus (cruroplasty) + envelopment of the lower esophagus by the gastric fundus → creates an artificial anti-reflux mechanism → Nissen total fundoplicature (360°): the gastric fundus completely surrounds the distal esophagus → maximum anti-reflux efficacy (elimination of objective GERD in 85-90 % of cases at 5 years) → but higher rate of post-operative dysphagia (10-20 % transient + 1-3 % persistent) + gas bloat syndrome (difficulty burping + bloating) → Toupet partial fundoplicature (270° posterior): the fundus surrounds the esophagus at 270° + leaves the anterior face free → less dysphagia + indicated if esophageal peristalsis ineffective on manometry + slightly inferior but acceptable anti-reflux results → Dor partial fundoplicature (180° anterior): mainly after Heller myotomy for achalasia → Hakanson 2019 - NEJM (LOTUS extended trial): fundoplicature vs PPI × 5 years → superior fundoplicature on acid exposure at 5 years → comparable clinical results → Evans 2017 - Cochrane: meta-analysis total vs partial fundoplicature → Toupet → less post-operative dysphagia → similar anti-reflux results → preference for Toupet if reduced peristalsis → long-term results of fundoplicature: success at 5-10 years: 80-90 % (GERD control) → recurrence rate: 10-20 % at 10 years (fundoplicature migration + hernia re-prolapse) → Anvari 2006 - Annals of Surgery: laparoscopic vs open fundoplicature → laparoscopic = better results + less morbidity → DeMeester 2009 - Annals of Thoracic Surgery: long-term results fundoplicature → 90 % follow-up at 10 years if correct technique → approaches: laparoscopic (standard) → 5 trocars + CO₂ insufflation + × 10 vision + return to work in 1-2 weeks → thoracoscopic (Belsey route - if hostile abdomen) → open (if laparoscopic failure or complex reoperation) → robotic surgery (di Vinci): potential advantage in reoperations + complex hernias + merits comparative studies vs laparoscopic; hiatal repair - cruroplasty + prosthetic mesh: simple closure of diaphragmatic pillars (sutures): standard technique → recurrence rate 20-30 % long-term for large hernias → prosthetic mesh around hiatus to reinforce repair: Frantzides 2002 - Journal of the American College of Surgeons: mesh + repair of large hernias → reduced recurrence rate from 26 % to 9 % at 5 years → but: complications of mesh: erosion into esophagus (serious complication - intra-luminal migration) + dysphagia + fibrosis → Oelschlager 2011 - Annals of Surgery: porcine bio-mesh (Surgisis) vs sutures alone → no significant reduction in recurrence rate at 5 years → mixed results on bio-mesh → current trend: selective mesh (bulky hernias + reoperations) + positioned in U-shape or halo without direct contact with esophagus → Collis-Nissen plasty if short esophagus: lengthening of the oesophagus by fundic incision (Collis gastroplasty) + fundoplicature → reserved if the oesophagus cannot be reduced to 2-3 cm intra-abdominally after reduction | Fundamental data on surgery: Galmiche 2011 - JAMA (LOTUS RCT n=554): PPI × 5 years vs laparoscopic Nissen → comparable clinical results + slightly superior fundoplication on acid exposure + Hakanson 2019 - NEJM (LOTUS extended 12 years): fundoplication → superior long-term GERD control → 92 % vs 85 % under PPI → but more adverse effects + Evans 2017 - Cochrane (meta-analysis 10 RCTs): Toupet vs Nissen → Toupet → less dysphagia + similar anti-reflux results → Toupet to be preferred if reduced peristalsis + Frantzides 2002 - JACS: synthetic mesh + large hernia → recurrence 9 % vs 26 % without mesh → significant reduction + Oelschlager 2011 - Annals of Surgery: bio-mesh vs sutures → no difference at 5 years → questions about usefulness of bio-mesh + Stylopoulos 2002 - Annals of Surgery: decision analysis asymptomatic HH → volvulus risk 1.1 %/year → NNT = 90 → operate asymptomatic HH if patient in good condition + bulky hernia + Anvari 2006 - Annals of Surgery: laparoscopic vs open → laparoscopic superior on morbidity + equivalent results + DeMeester 2009 - Annals of Thoracic Surgery: 10-year results laparoscopic fundoplicature → 90 % control → durable results if correct technique |
| Special situations and complications Gastric volvulus — emergency — giant hernia — pregnancy — obesity — bariatric surgery — recurrence — revision surgery |
Acute gastric volvulus on hiatal hernia - surgical emergency: mechanism: rotation of the stomach around its axis in the hernia → obstruction with vascular occlusion → ischemia + necrosis → Borchardt triad (1904): vomiting without regurgitation (inability to vomit if pylorus is obstructed) + intense epigastric pain + inability to pass a nasogastric tube → mortality rate if gastric necrosis: >50 % → urgent management: emergency thoracoabdominal CT + confirmation of diagnosis + emergency surgery: reduction + assessment of gastric vitality + resection if necrosis + hiatal repair + fundoplicature → Goitein 2013 - Surgical Endoscopy: acute gastric volvulus on HH → emergency laparoscopy possible by experienced teams → endoscopic reduction attempt if unstable patient (may precede surgery); giant hernia (type III-IV) - specifics: resection of hernia sac mandatory (if left in place → recurrence certain) + reduction of hernial contents + inspection of viability of herniated organs + reinforced closure of hiatus (mesh if necessary) + systematic fundoplicature to restore anti-reflux mechanism + abdominal gastropexy (fixation of stomach to anterior abdominal wall) often associated to prevent recurrence; hiatal hernia and pregnancy: physiological in late pregnancy (displacement of diaphragm + high intra-abdominal pressure) → treated with strict conservative measures → PPI if necessary (esomeprazole or omeprazole: reassuring safety data - Matok 2012 - Alimentary Pharmacology and Therapeutics : PPI pregnancy → no increase in malformative risk) → surgery postponed to postpartum unless complication (volvulus + strangulation); hiatal hernia and obesity: obesity significantly increases the risk of post-surgical recurrence → recommendation: prior weight loss if BMI >40 + bariatric surgery (sleeve gastrectomy + gastric bypass) combined with fundoplication if BMI >35-40 + symptomatic HH → Daes 2011 - Surgical Endoscopy: sleeve gastrectomy + HH → systematic hiatal repair at time of sleeve → reduces post-sleeve GERD + Mechanick 2020 - American Society of Metabolic and Bariatric Surgery: Roux-en-Y gastric bypass = best option if GERD + morbid obesity (reduces GERD by bile detour + acid reduction) vs sleeve (often worsens existing GERD); revision surgery for recurrent hiatal hernia: causes of recurrence: insufficient hiatus closure + insufficient mesh + untreated obesity + insufficient sac resection + necrosis of a pillar + fundoplicature migration (Slipped Nissen) → full pre-operative workup essential: TOGD + manometry + pH-metry + CT + EOGD → increased technical difficulty: adhesions + altered anatomy → robotic surgery advantageous in this context + increased morbidity (5-10 % conversion to laparotomy); conversion to surgery after fundoplicature failure: if persistent dysphagia on too-tight Nissen → pneumatic dilatation or surgical revision + if GERD recurs post-fundoplicature: check compliance + pH-metry → if true recurrence → surgical revision or PPI optimization. | Data on special situations and complications: Goitein 2013 - Surgical Endoscopy: emergency laparoscopy + gastric volvulus → feasibility in experienced centers → results equivalent to emergency laparotomy + Stylopoulos 2002 - Annals of Surgery: risk of volvulus on asymptomatic HH → 1.1 %/year → NNT elective surgery 90 to avoid emergency → Daes 2011 - Surgical Endoscopy: sleeve + systematic hiatal repair → reduction of post-sleeve GERD → practice now recommended + Mechanick 2020 - ASMBS: Roux-en-Y gastric bypass = preferred option if severe GERD + morbid obesity + Frantzides 2002 - JACS: mesh + large hernias → reduced recurrence + Matok 2012 - APT: PPI pregnancy → safety confirmed in meta-analyses + Jacobson 2006 - NEJM: weight loss + significant reduction in GERD → prevention and treatment of sliding hiatal hernia → Hakanson 2019 - NEJM: long-term durable fundoplicature → confirmation that surgery is effective and durable if performed well |
ℹ️
A sliding hiatal hernia does not require surgery if it responds well to PPIs and lifestyle changes. The vast majority of type I hiatal hernias are treated medically with excellent results. Surgery is reserved for refractory or complicated forms. On the other hand, any large or symptomatic paraesophageal hernia (types II-IV) warrants surgical evaluation, as the risk of acute gastric volvulus is real and the mortality rate of this complication is high if management is delayed.
Situations Requiring a 911 Call or Urgent Medical Attention
Severe chest and epigastric pain with vomiting without regurgitation and inability to pass a nasogastric tube in a patient with a known or large hiatal hernia. → Borchardt's triad → acute gastric volvulus → call 911 → surgical emergency → emergency thoraco-abdominal CT scan → emergency surgery → high risk of gastric necrosis and mortality without prompt intervention.
Voluminous hiatal hernia known + progressive dysphagia + early satiety + repeated postprandial vomiting + recurrent chest pain → Symptomatic paraesophageal hernia → urgent surgical consultation → Barium swallow + CT scan + elective surgery planning → do not wait for an acute volvulus episode.
Unexplained iron deficiency anemia or lower gastrointestinal bleeding in a patient with a large hiatal hernia Cameron's ulcer (linear ulcerations at the gastric cardia) → urgent upper gastrointestinal endoscopy → biopsies + high-dose PPI treatment + or hernia surgery if recurrent anemia despite PPI.
Severe heartburn and regurgitation + nocturnal cough + chronic hoarseness despite twice-daily PPIs for 3 months → Refractory GERD on hiatal hernia → Gastroenterology consultation → EGD + manometry + 24h pH monitoring → Pre-surgical workup if indicated → Do not indefinitely increase PPIs without investigation.
Consult at Clinique Omicron
Doctors at Clinique Omicron evaluate symptoms of gastroesophageal reflux disease and hiatal hernia, prescribe medical treatment with PPIs and lifestyle modifications, order appropriate diagnostic tests (UGIB, endoscopy, pH monitoring), refer patients to a gastroenterologist or colorectal surgeon based on severity, and provide follow-up care for patients undergoing treatment. Consultations are available at several service locations in Quebec and via telemedicine. To book an appointment, visit cliniqueomicron.ca.
The content of this page is for informational purposes only and does not substitute for medical or surgical digestive advice. Severe chest pain associated with vomiting and a known hiatal hernia is a surgical emergency requiring an immediate call to 911.
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