From the Guidelines
Hyperlipasemia is not directly associated with hiatal hernia, as there is no clear evidence linking the two conditions 1.
Hiatal Hernia Classification
Hiatal hernias are classified into four main types, including:
- Type I: sliding hiatal hernia, the most common type (90%), where the esophageal hiatus is widened, allowing herniation of the gastric cardia 1
- Type II: paraesophageal hiatal hernia, accounting for 10% of hiatal hernias, where the defect is in the phrenoesophageal membrane, allowing herniation of the gastric fundus
- Type III: a combination of Type I and Type II hiatal hernias, with a superiorly displaced gastroesophageal junction
- Type IV: a significantly large diaphragmatic hernia that can accommodate the herniation of additional viscera, including the stomach, colon, and spleen 1
Management
However, lipase elevation in the context of a hiatal hernia may indicate pancreatitis or pancreatic injury, possibly due to the hernia causing compression or obstruction of the pancreatic ducts, and should be managed conservatively with close monitoring of lipase levels, abdominal pain, and other symptoms. Medications such as proton pump inhibitors (PPIs) like omeprazole 20mg orally twice daily or lansoprazole 30mg orally twice daily may be prescribed to reduce stomach acid and alleviate symptoms, and pain management with acetaminophen 650mg orally every 4-6 hours as needed may be necessary. In cases of severe symptoms or significant lipase elevation, hospitalization for further evaluation and treatment may be required, and surgical intervention to repair the hiatal hernia should be considered if conservative management fails or if complications arise 1. The patient should be advised to avoid heavy meals, fatty foods, and alcohol to reduce the risk of exacerbating the condition, and follow-up appointments with a gastroenterologist or surgeon are crucial to monitor the patient's condition and adjust the treatment plan as necessary.
From the Research
Hyperlipasemia and Hiatal Hernia
- Hyperlipasemia, or elevated serum lipase levels, can be associated with hiatal hernia, particularly in cases where the pancreas is herniated through the diaphragm 2, 3, 4, 5.
- Studies have shown that hiatal hernia can cause pancreatitis, which can lead to hyperlipasemia, due to the diaphragmatic crura impinging upon the pancreas, intermittent folding of the main pancreatic duct, ischemia associated with stretching at its vascular pedicle, or total pancreatic incarceration 3, 4.
- In some cases, hiatal hernia can cause acute pancreatitis, which can be diagnosed by elevated serum amylase and lipase levels, and can be treated conservatively or surgically depending on the severity of the condition 2, 4, 5.
- It is essential to consider hiatal hernia as a potential cause of hyperlipasemia and pancreatitis, especially in elderly patients presenting with chest pain and negative cardiopulmonary evaluation 2, 3.
- While the majority of the studies focus on the association between hiatal hernia and pancreatitis, one study reports a case of gastric outlet obstruction with elevated serum pancreatic lipase secondary to an infraumbilical hernia, highlighting the potential for other types of hernias to cause hyperlipasemia 6.