**Question:** Hiatus hernia is treated by-

a) Surgery when medical treatment has failed
b) Nissen's fundoplication
c) Medical treatment only
d) None of the above

**Core Concept:** Hiatus hernia is a condition where the upper part of the stomach pushes through a gap in the diaphragm called the hiatus into the chest cavity. This leads to reflux of stomach contents into the oesophagus, causing symptoms like heartburn, regurgitation, and chest pain. Treatment options include medical management, surgical intervention, and a combination of both.

**Why the Correct Answer is Right:**

The correct answer is "c) Medical treatment only" because, in most cases, hiatus hernia can be effectively managed with medical treatment alone. Medical treatment aims to control symptoms by blocking the production of gastric acid, reducing its secretion, or increasing the rate at which the stomach empties its contents.

**Why Each Wrong Option is Incorrect:**

a) Surgery when medical treatment has failed: Although surgery may be considered in severe cases where medical treatment is ineffective, the correct answer doesn't support surgery as the sole treatment option.

b) Nissen's fundoplication: Nissen's fundoplication is a surgical procedure that wraps the upper part of the stomach around the esophagus to strengthen the lower esophageal sphincter, effectively reducing reflux symptoms. This option is incorrect as it is one of the surgical interventions mentioned, not the only treatment approach.

d) None of the above: This answer is incorrect because it fails to address the medical treatment options available for managing hiatus hernia-related symptoms.

**Clinical Pearl:** Hiatus hernia can be managed effectively with a combination of lifestyle modifications, proton pump inhibitors (PPIs), and antacids. In severe cases or when medical treatment is inadequate, surgical intervention like Nissen's fundoplication may be considered. Understanding the appropriate treatment options and selecting the right management plan based on symptom severity and response to medical treatment is crucial for effective management of hiatus hernia.