Hills Grading Hiatus Hernia: Symptoms & Treatment

Hills grading, a key endoscopic assessment tool, significantly aids in the diagnosis of a hiatus hernia. A hiatus hernia, a condition where the stomach protrudes through the diaphragm, can manifest with varying degrees of severity. Symptoms associated with this condition include acid reflux, which can be managed through lifestyle modifications or, in some cases, surgical intervention guided by protocols established by organizations such as the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES). Accurate diagnosis and grading of a hiatus hernia, particularly using the Hills grading hiatus hernia system, are crucial for determining the most effective treatment strategy and improving patient outcomes.

Understanding Hiatal Hernias and the Hill Classification

A hiatal hernia arises when a portion of the stomach abnormally protrudes through the esophageal hiatus, an opening in the diaphragm normally reserved for the esophagus. This protrusion disrupts the natural anatomical barrier that prevents stomach acid from flowing back into the esophagus. Understanding the nature and extent of this protrusion is critical for effective management.

Types of Hiatal Hernias

Hiatal hernias are broadly classified into two main types: sliding and paraesophageal.

Sliding Hiatal Hernias

In a sliding hiatal hernia, the gastroesophageal junction itself slides upwards into the chest, along with a portion of the stomach. This is the more common type.

Paraesophageal Hiatal Hernias

In contrast, a paraesophageal hernia involves the stomach herniating alongside the esophagus, while the gastroesophageal junction remains in its normal position. This type, while less frequent, carries a higher risk of complications.

The Hill Classification: A System for Severity Assessment

The Hill classification, developed by Dr. Allison B. Hill, provides a standardized method for grading the severity of hiatal hernias. This classification system is based on endoscopic findings during an upper endoscopy. It focuses on the appearance and function of the gastroesophageal junction (GEJ) and the presence of a flap valve mechanism, which normally prevents reflux.

Purpose of the Hill Classification

The primary purpose of the Hill classification is to provide a consistent and objective assessment of hiatal hernia severity. It enables clinicians to communicate effectively about the condition and to guide treatment decisions. By categorizing the anatomical and functional abnormalities observed during endoscopy, the Hill classification helps to differentiate between mild and severe cases, which may require different management strategies.

Importance in Clinical Decision-Making and Treatment Planning

The Hill classification plays a vital role in clinical decision-making. It helps physicians determine the appropriate course of action for patients with hiatal hernias. For example, a patient with a Hill Grade I hernia may be managed with lifestyle modifications and medications, while a patient with a Hill Grade IV hernia may require surgical intervention.

The classification assists in tailoring treatment plans to the individual needs of each patient, ensuring that interventions are proportionate to the severity of the condition. Ultimately, the Hill classification enhances the precision and effectiveness of hiatal hernia management.

Understanding the Gastroesophageal Junction and Flap Valve

To fully appreciate the nuances of the Hill classification and its implications for hiatal hernia severity, it's essential to delve into the anatomy and functionality of the gastroesophageal junction (GEJ) and the flap valve mechanism. These structures are the body's primary defense against acid reflux, and their compromise is central to the development and progression of hiatal hernia-related symptoms.

The Gastroesophageal Junction: A Critical Barrier

The gastroesophageal junction (GEJ) marks the transition point between the esophagus and the stomach. It's not merely a simple connection; it is a specialized region designed to prevent the backflow of stomach contents into the esophagus.

This junction maintains a high-pressure zone, the lower esophageal sphincter (LES), which normally remains contracted to prevent reflux.

The LES relaxes during swallowing to allow food to pass into the stomach and then promptly contracts again.

A properly functioning GEJ is paramount in preventing the corrosive effects of stomach acid from damaging the delicate esophageal lining.

The Flap Valve Mechanism: An Anatomical Anti-Reflux System

The flap valve mechanism is another critical component of the anti-reflux barrier at the GEJ. This mechanism describes the anatomical arrangement where the angle of entry of the esophagus into the stomach creates a one-way valve.

As pressure increases in the stomach, the esophageal angle is compressed, further sealing the junction.

This natural "kink" in the anatomy prevents stomach contents from easily refluxing back into the esophagus.

The integrity of the flap valve is closely linked to the position of the GEJ relative to the diaphragm.

Competence and the Severity of Reflux

The competence of both the LES and the flap valve directly influences the severity of reflux. When either of these mechanisms is compromised, the risk of acid exposure to the esophagus increases.

A weak LES allows stomach acid to frequently escape into the esophagus.

Similarly, a distorted or ineffective flap valve fails to provide adequate resistance against reflux.

In hiatal hernias, the GEJ often migrates above the diaphragm, disrupting both the LES pressure and the flap valve angle.

This disruption leads to a significant increase in the likelihood of acid reflux and its associated complications.

Hiatal Hernias and a Compromised Flap Valve

Hiatal hernias fundamentally alter the anatomy of the GEJ, directly affecting the flap valve mechanism.

When the stomach protrudes through the diaphragm, the angle of the esophagus entering the stomach is widened and flattened.

This loss of the acute angle diminishes the effectiveness of the flap valve, rendering it less capable of preventing reflux.

Furthermore, the displaced GEJ is no longer supported by the surrounding diaphragmatic muscles, further weakening the anti-reflux barrier.

The combination of a compromised flap valve and a weakened LES creates a perfect storm for GERD symptoms such as heartburn, regurgitation, and esophagitis. Understanding the interplay between these anatomical structures is crucial for interpreting the Hill classification and guiding treatment decisions for hiatal hernias.

Decoding the Hill Grading System: A Detailed Explanation

To fully appreciate the nuances of the Hill classification and its implications for hiatal hernia severity, it's essential to delve into a detailed explanation of each grade within the system.

This classification, based on endoscopic findings, offers a standardized way to assess the competence of the gastroesophageal junction (GEJ) and the degree of stomach protrusion into the chest. Understanding these grades is crucial for clinicians in determining the most appropriate treatment strategies.

Hill Grade I: The Gold Standard

Hill Grade I represents the ideal endoscopic appearance of the GEJ.

In this grade, the flap valve is prominently visible and tightly closed.

There is typically no visible hiatal hernia, and the GEJ appears as a distinct, well-defined structure. The gastric folds are clearly seen abutting the esophagus, indicating a competent barrier against reflux.

This grade signifies a healthy and functional GEJ, effectively preventing the backflow of stomach acid into the esophagus.

Hill Grade II: Minor Compromise

Hill Grade II indicates a slight compromise in the competence of the flap valve.

While a flap valve is still present, it may not be as tightly closed as in Grade I. The gastric folds are visible and can be seen abutting the esophagus, but there may be a possibility of opening during evaluation.

A small hiatal hernia may or may not be present. This grade suggests a potential for mild reflux, although it may not always be clinically significant.

The key difference from Grade I lies in the slightly reduced competence of the flap valve.

Hill Grade III: Significant Dysfunction

Hill Grade III signifies a more significant degree of dysfunction at the GEJ.

The flap valve is blunted and may appear less prominent, with its ability to completely close often compromised.

A hiatal hernia is typically present in this grade, with a noticeable portion of the stomach protruding into the chest. Spontaneous, intermittent opening of the GEJ is usually seen.

The gastric folds are still present but are seen less consistently in apposition with the esophagus.

This grade indicates a higher likelihood of GERD and associated symptoms compared to Grades I and II.

The distinction from the earlier grades is the clear evidence of a compromised flap valve and the presence of a hiatal hernia.

Hill Grade IV: Severe Incompetence

Hill Grade IV represents the most severe form of GEJ incompetence.

In this grade, there is no discernible flap valve. The GEJ is widely open, allowing for free reflux of stomach contents into the esophagus.

A large hiatal hernia is invariably present, with a significant portion of the stomach located in the chest. There is also no gastric fold abutting the esophagus as well.

This grade indicates a high risk of severe GERD, esophagitis, and other complications.

The defining characteristic of Grade IV is the complete absence of a functional flap valve, representing a total breakdown of the anti-reflux barrier. This is considered a large hiatal hernia.

Visual Aids and Endoscopic Interpretation

While a written description is helpful, visual aids such as endoscopic images or diagrams are invaluable in understanding the nuances of each Hill grade. Endoscopists use these criteria in real-time to assess the GEJ during upper endoscopy procedures. The Hill grading is a subjective visual evaluation and can vary between endoscopists.

The interpretation of the Hill score must also be considered in the context of the patient's symptoms and other clinical findings to guide the decision-making process.

The Endoscopic Hill Score: How It's Assigned

To fully appreciate the nuances of the Hill classification and its implications for hiatal hernia severity, it's essential to delve into the detailed process of assigning the Hill score during an upper endoscopy (EGD) procedure. This assessment, performed during the endoscopic evaluation, provides a standardized method for grading the severity of a hiatal hernia based on direct visual observations.

Endoscopic Evaluation: A Direct Visual Assessment

The Hill score is not merely a number; it is a comprehensive assessment derived from direct visualization during an upper endoscopy, also known as esophagogastroduodenoscopy (EGD). During this procedure, a gastroenterologist guides a flexible endoscope, equipped with a camera, through the esophagus, stomach, and duodenum.

This allows for real-time examination of the gastroesophageal junction (GEJ) and the surrounding anatomical structures. The assignment of the Hill score hinges on the endoscopist's ability to meticulously observe and interpret several key factors.

Key Factors in Hill Score Assignment

Several factors are meticulously assessed during the endoscopic evaluation to determine the appropriate Hill grade. These factors include the appearance and function of the GEJ and the degree of stomach protrusion.

Visual Assessment of the GEJ and Flap Valve

The visual assessment of the GEJ is paramount in determining the Hill score. The endoscopist carefully examines the position and competence of the flap valve, which is crucial for preventing reflux.

In a healthy GEJ, the flap valve should be tightly apposed to the endoscope, creating a rosette-like appearance. The valve should also be responsive to changes in intra-abdominal pressure.

The endoscopist notes the degree to which the valve effectively closes around the endoscope, the presence of any laxity or gaping, and its overall ability to prevent the backflow of gastric contents.

A competent flap valve tightly adheres to the endoscope, whereas an incompetent valve may appear open or flattened. The degree of opening directly correlates with the severity of the hiatal hernia.

Assessing Stomach Protrusion

The extent of stomach protrusion above the diaphragm is another critical determinant in assigning the Hill score. The endoscopist observes the amount of stomach tissue that has herniated into the chest cavity.

A larger degree of protrusion typically indicates a more severe hiatal hernia and a higher Hill grade.

It's not just the size of the hernia that matters but also its configuration and the relationship to the esophagus. The endoscopist carefully documents these findings to arrive at an accurate assessment.

By considering these factors, the endoscopist assigns a Hill grade ranging from I to IV, providing a standardized assessment of hiatal hernia severity that guides clinical management and treatment decisions.

Diagnosing Hiatal Hernias: The Role of Endoscopy and Barium Swallow

To fully appreciate the nuances of the Hill classification and its implications for hiatal hernia severity, it's essential to delve into the detailed process of assigning the Hill score during an upper endoscopy (EGD) procedure. This assessment, performed during the endoscopic evaluation, provides a standardized method for grading the hernia based on visual cues. It also gives invaluable insight into the structural integrity of the gastroesophageal junction.

Upper Endoscopy (EGD): Direct Visualization

The upper endoscopy, or esophagogastroduodenoscopy (EGD), stands as the gold standard for diagnosing hiatal hernias. It also directly assesses the esophageal lining and the gastroesophageal junction (GEJ). This procedure allows a gastroenterologist to visualize the esophagus, stomach, and duodenum using a flexible tube with a camera attached.

During the EGD, the endoscope is carefully advanced through the mouth, down the esophagus, and into the stomach. This provides a clear, real-time view of the esophageal lining. It also allows for careful examination of the GEJ where the esophagus meets the stomach.

The ability to directly visualize the GEJ is paramount. It's what enables the accurate assessment of the Hill grade. This grading relies on specific endoscopic characteristics, such as the position of the GEJ relative to the diaphragmatic hiatus and the competence of the flap valve.

Assessing the Hill Grade Endoscopically

The endoscopist meticulously observes the GEJ to determine the Hill grade. The assessment involves evaluating several key features. These include the degree of gastric fold prominence, the ease with which the GEJ opens and closes, and the presence and extent of any hiatal hernia.

In a Hill Grade I hernia, the GEJ is tightly closed. The gastric folds are prominently visible. As the grade increases, the GEJ becomes progressively more lax. Gastric folds appear less defined. In the most severe cases (Grade IV), the GEJ is widely open, allowing for significant herniation of the stomach into the chest.

The endoscopist can directly observe the degree of stomach protrusion through the diaphragmatic hiatus. Any signs of inflammation or damage to the esophageal lining (esophagitis) are also noted. This comprehensive visual assessment allows for accurate staging of the hiatal hernia.

Barium Swallow (Esophagogram): An Adjunct Diagnostic Tool

The barium swallow, also known as an esophagogram, is an alternative diagnostic imaging technique. It involves the patient swallowing a liquid containing barium, which is radiopaque and visible on X-rays.

As the barium passes through the esophagus, a series of X-ray images are taken. These images allow the radiologist to visualize the structure and function of the esophagus, stomach, and GEJ. The Barium Swallow is especially helpful in evaluating the size and location of the hiatal hernia.

Complementary Roles: Endoscopy and Barium Swallow

While endoscopy remains the primary diagnostic tool, the barium swallow can offer valuable complementary information.

The barium swallow can be particularly useful in identifying large hiatal hernias or assessing esophageal motility disorders that may contribute to GERD symptoms. It is non-invasive and can provide a broader overview of the upper digestive tract.

However, it's important to acknowledge the limitations of the barium swallow. It provides less detailed information about the esophageal lining and the GEJ than endoscopy.

It cannot directly assess the Hill grade or detect subtle signs of esophagitis. Therefore, endoscopy is typically preferred when detailed visualization and tissue sampling are necessary.

In conclusion, both upper endoscopy and barium swallow play crucial roles in the diagnosis of hiatal hernias. Endoscopy allows for direct visualization and assessment of the Hill grade. Barium swallow provides a broader overview of the esophagus and stomach. The choice of diagnostic procedure depends on the individual patient's symptoms, clinical presentation, and the need for detailed visualization and tissue sampling.

[Diagnosing Hiatal Hernias: The Role of Endoscopy and Barium Swallow To fully appreciate the nuances of the Hill classification and its implications for hiatal hernia severity, it's essential to delve into the detailed process of assigning the Hill score during an upper endoscopy (EGD) procedure. This assessment, performed during the endoscopic eval...]

Hiatal Hernias, GERD, and Associated Conditions

Hiatal hernias are frequently intertwined with other medical conditions, most notably Gastroesophageal Reflux Disease (GERD). Understanding this complex interplay is crucial for effective diagnosis and management.

This section explores the intricate relationship between hiatal hernias, GERD, and the potential complications that can arise.

The Hiatal Hernia-GERD Connection: A Vicious Cycle

The relationship between hiatal hernias and GERD is often bidirectional. A hiatal hernia can exacerbate GERD, and conversely, chronic GERD may contribute to the development or worsening of a hiatal hernia.

A hiatal hernia disrupts the normal function of the lower esophageal sphincter (LES), allowing stomach acid to reflux into the esophagus.

This reflux can cause inflammation and damage to the esophageal lining, perpetuating a cycle of injury and impaired function.

Common Symptoms of GERD

GERD manifests through various symptoms, with heartburn and acid reflux being the most prevalent. Heartburn is typically described as a burning sensation in the chest, often rising towards the throat.

Acid reflux involves the regurgitation of stomach contents into the esophagus or mouth.

Other common symptoms include:

• Regurgitation: The effortless backflow of stomach contents.
• Dyspepsia: General discomfort or pain in the upper abdomen.
• Chronic cough: Persistent coughing, especially at night.

Potential Complications of Hiatal Hernias and Untreated GERD

Untreated or poorly managed hiatal hernias and GERD can lead to severe complications.

Esophagitis: Inflammation of the Esophagus

Chronic acid exposure can cause esophagitis, leading to inflammation, ulceration, and scarring of the esophageal lining.

Persistent esophagitis increases the risk of developing more serious conditions.

Barrett's Esophagus: A Precancerous Condition

Barrett's esophagus is a condition where the normal squamous cell lining of the esophagus is replaced by columnar epithelium, similar to that found in the intestine.

This metaplastic change is a direct consequence of chronic acid exposure and is considered a precancerous condition.

Patients with Barrett's esophagus have a significantly increased risk of developing esophageal adenocarcinoma.

Regular endoscopic surveillance is critical for early detection and management of dysplasia, a precursor to cancer.

Other Potential Symptoms

Beyond the classic GERD symptoms, hiatal hernias can present with other less common but equally significant manifestations.

Dysphagia: Difficulty Swallowing

Large hiatal hernias can mechanically obstruct the esophagus, leading to dysphagia, or difficulty swallowing.

This symptom can significantly impact a person's quality of life and nutritional intake.

Chest Pain

Hiatal hernias can cause non-cardiac chest pain, mimicking the symptoms of heart disease.

This can lead to unnecessary anxiety and extensive cardiac evaluations.

It is essential to differentiate hiatal hernia-related chest pain from cardiac causes.

Managing Hiatal Hernias: Treatment Options

To fully appreciate the nuances of the Hill classification and its implications for hiatal hernia severity, it's essential to delve into the detailed process of assigning the Hill score during an upper endoscopy (EGD) procedure. This assessment, performed during the endoscopic evaluation, directly impacts the subsequent management strategies.

The spectrum of treatment options for hiatal hernias is broad, ranging from conservative medical management and lifestyle adjustments to more invasive surgical interventions. The chosen approach hinges on several factors, most notably the severity of symptoms, the Hill grade, the presence of complications, and the patient's overall health status.

Medical Management

The initial line of defense in managing hiatal hernias typically involves medical management, primarily aimed at alleviating symptoms and preventing complications associated with gastroesophageal reflux.

Proton Pump Inhibitors (PPIs)

PPIs represent the cornerstone of medical therapy. These medications work by irreversibly inhibiting the proton pump in parietal cells, thereby drastically reducing gastric acid production. Common PPIs include omeprazole, lansoprazole, and pantoprazole.

The efficacy of PPIs in controlling acid reflux is well-established, and they are often the first-line treatment for patients with GERD-related symptoms associated with hiatal hernias. However, long-term use of PPIs can be associated with certain risks, including an increased risk of bone fractures, vitamin B12 deficiency, and certain infections. Therefore, the duration and necessity of PPI therapy should be regularly reassessed by a physician.

H2 Blockers

H2 receptor antagonists, or H2 blockers, such as ranitidine, famotidine, and cimetidine, work by blocking histamine H2 receptors in the stomach. These receptors stimulate acid secretion, so blocking them reduces acid production, although to a lesser extent than PPIs.

H2 blockers are often used for mild to moderate GERD symptoms and can be particularly helpful for nighttime acid control. However, they are generally less potent than PPIs and may not be as effective in treating more severe cases of esophagitis.

Antacids

Antacids, such as calcium carbonate (Tums) and aluminum hydroxide (Maalox), provide rapid, but short-lived, relief from heartburn and acid reflux. They work by neutralizing stomach acid, thereby reducing the irritation of the esophageal lining.

While antacids can be helpful for occasional symptom relief, they do not address the underlying cause of the hiatal hernia or GERD. Furthermore, frequent use of antacids can lead to side effects such as constipation or diarrhea.

Lifestyle and Dietary Modifications

Lifestyle and dietary changes are essential components of managing hiatal hernias and can significantly reduce the frequency and severity of GERD symptoms.

Elevation of the Head of the Bed

Elevating the head of the bed by 6 to 8 inches can help prevent nighttime acid reflux by using gravity to keep stomach acid from flowing back into the esophagus. This can be achieved by using bed risers or placing a wedge-shaped pillow under the mattress.

Avoiding Trigger Foods and Beverages

Certain foods and beverages are known to trigger GERD symptoms in many individuals. Common culprits include:

• Fatty foods
• Spicy foods
• Citrus fruits
• Chocolate
• Caffeine
• Alcohol

Identifying and avoiding these trigger foods can help minimize reflux episodes. Keeping a food diary can be a useful tool for pinpointing specific dietary triggers.

Surgical Interventions

When medical management and lifestyle changes fail to provide adequate symptom relief or when complications arise, surgical intervention may be considered.

Fundoplication

Fundoplication is a surgical procedure designed to reinforce the lower esophageal sphincter (LES) and prevent acid reflux.

During fundoplication, the upper portion of the stomach (the fundus) is wrapped around the lower esophagus.

There are several variations of fundoplication, including:

• Nissen fundoplication: The fundus is wrapped completely (360 degrees) around the esophagus.
• Toupet fundoplication: The fundus is wrapped partially (270 degrees) around the esophagus.

The choice of fundoplication technique depends on the individual patient's anatomy and the surgeon's preference.

Laparoscopic Surgery

Fundoplication is typically performed laparoscopically, a minimally invasive approach that involves making small incisions in the abdomen.

A laparoscope, a thin, flexible tube with a camera attached, is inserted through one of the incisions to provide a magnified view of the surgical site.

Laparoscopic surgery offers several advantages over traditional open surgery, including:

• Smaller incisions
• Less pain
• Shorter hospital stay
• Faster recovery

However, not all patients are candidates for laparoscopic surgery, and the decision to proceed with this approach is made on a case-by-case basis.

The Medical Team: Specialists Involved in Hiatal Hernia Care

Managing hiatal hernias effectively requires a collaborative approach, drawing upon the expertise of various medical specialists. The diagnostic journey, treatment decisions, and long-term management strategies all benefit from the insights of professionals with specialized knowledge in gastroenterology and surgery. Understanding the roles of these specialists is crucial for patients navigating their care.

Gastroenterologists: The Gatekeepers of Diagnosis and Medical Management

Gastroenterologists are at the forefront of diagnosing and medically managing hiatal hernias and related conditions. Their expertise lies in the digestive system, encompassing the esophagus, stomach, and intestines.

• Diagnosis and Assessment: Gastroenterologists perform upper endoscopies (EGDs), a critical procedure for visualizing the esophagus, stomach, and gastroesophageal junction (GEJ). This allows them to identify hiatal hernias, assess their severity using the Hill classification, and rule out other potential causes of symptoms.

• Medical Management and Symptom Control: A core role of the gastroenterologist is crafting a personalized medical management plan. This often includes prescribing medications to reduce acid production, such as proton pump inhibitors (PPIs) or H2 blockers. They also guide patients on lifestyle and dietary modifications to minimize reflux symptoms.

• Long-term Monitoring: Gastroenterologists provide ongoing monitoring to assess the effectiveness of treatment and detect any potential complications, such as esophagitis or Barrett's esophagus. Regular follow-up appointments are essential for long-term management and preventing disease progression.

• Collaboration with Other Specialists: When surgery is deemed necessary, gastroenterologists work closely with surgeons to ensure a coordinated approach to patient care. They provide essential information about the patient's condition and medical history to guide surgical planning.

Surgeons: Restoring Anatomy and Relieving Reflux

When medical management fails to provide adequate symptom relief or when complications arise, surgical intervention may be necessary. Surgeons specializing in hiatal hernia repair aim to restore the normal anatomy of the GEJ and prevent reflux. Two primary types of surgeons may be involved: general surgeons and thoracic surgeons.

• General Surgeons: General surgeons with experience in upper gastrointestinal surgery often perform hiatal hernia repairs, particularly fundoplication procedures. They are adept at both open and laparoscopic surgical techniques.

  • Fundoplication Procedures: Fundoplication involves wrapping the upper part of the stomach around the esophagus to reinforce the lower esophageal sphincter (LES). This strengthens the barrier against acid reflux. The most common approach is the Nissen fundoplication, but variations like the Toupet fundoplication may be used based on individual patient needs.

  • Laparoscopic Approach: The laparoscopic approach, using minimally invasive techniques, is now the standard for most hiatal hernia repairs. This approach offers several advantages, including smaller incisions, reduced pain, and faster recovery times.

• Thoracic Surgeons: In complex cases, such as large paraesophageal hernias or those involving the chest cavity, a thoracic surgeon may be consulted.

  • Expertise in Chest Cavity Procedures: Thoracic surgeons have specialized training in operating within the chest cavity and can address any associated issues involving the lungs or mediastinum. They may perform hiatal hernia repair through open or minimally invasive approaches.
• Pre-operative and Post-operative Care: Surgeons provide comprehensive pre-operative assessments to determine patient suitability for surgery. They also manage post-operative care to ensure proper healing and prevent complications.

The Synergy of Care: A Team-Based Approach

Optimal hiatal hernia management hinges on effective communication and collaboration between gastroenterologists and surgeons. This team-based approach ensures that patients receive comprehensive care tailored to their individual needs.

• Coordinated Treatment Plans: By working together, these specialists can develop treatment plans that integrate medical management, lifestyle modifications, and surgical interventions when appropriate.
• Shared Decision-Making: The best outcomes are achieved when patients are actively involved in shared decision-making with their medical team. Understanding the benefits and risks of different treatment options empowers patients to make informed choices about their care.
• Improved Patient Outcomes: A collaborative approach leads to improved patient outcomes, reduced complications, and enhanced quality of life.

So, if you suspect you might be dealing with a hills grading hiatus hernia, don't hesitate to chat with your doctor. Getting a proper diagnosis and exploring treatment options is the best way to manage your symptoms and get back to feeling like yourself again. Good luck, and here's to your health!