Hiatal hernia is called when the upper part of the stomach shifts up through the diaphragm into the chest area. The hiatus is an opening in the diaphragm, the muscular wall separating the chest cavity from the abdomen. Normally, the esophagus passes through the hiatus and connects to the stomach. In a hiatal hernia, the stomach bulges into the chest through this opening.
The exact cause of hiatal hernias is unknown. In some people, it has been suggested that a possible injury to the area or other damage may weaken the muscle tissue. Putting too much pressure (repeatedly) on the muscles around the stomach is also thought to be a risk factor. This can happen with: coughing, vomiting, straining during defecation, lifting heavy objects.
Obesity, ageing and smoking can also increase the risk of this disease.
There are usually two types of hiatal hernia:
- sliding hiatal hernias
- fixed or paraesophageal hernias
Slipped hiatal hernia
In a sliding hiatal hernia, the stomach and the section of esophagus that joins the stomach slide up into the chest through the hiatus. This is the most common type of hernia. These sliding hiatal hernias are suggestive of reflux disease and many patients suffer symptoms such as regurgitation (heartburn) and burning behind the breastbone.
Gastroesophageal reflux disease (GERD) occurs when food, fluids and acid in the stomach get caught in the esophagus. This can lead to heartburn or nausea after eating. Usually, people with hiatal hernia have GERD.
Slipped hernias are usually small and may not need treatment.
Fixed or paraesophageal hiatal hernia
Paraesophageal hernia is less common but is a more serious cause for concern. In many patients, paraesophageal hernias may give no indication. These asymptomatic hernias require regular monitoring and do not require surgical treatment.
When a paraesophageal hernia begins to cause discomfort - sudden sharp pain in the chest and upper abdomen, combined with nausea and vomiting, this is an indicative complication that requires urgent surgical treatment. In such a case, there is a high risk of complication of the condition leading to gastric obstruction or ischaemia (blood supply to the stomach is cut off), which is life-threatening.
Common symptoms of paraesophageal hernia are:
- Chest pain - there are many causes leading to chest pain. It is important that patients who are diagnosed with a large paraesophageal hernia undergo a cardiology examination. Hiatal hernia pain resembles heart disease in nature and localization. A common symptom is shortness of breath and palpitations. There is no clear relationship between hernia size and severity of symptoms.
- Epigastric pain - represents pain in the middle, upper abdomen.
- Dysphagia - difficulty swallowing.
- Shortness of breath - in some very large paraesophageal hernias, the stomach can press on the diaphragm or squeeze the lungs, contributing to a feeling of shortness of breath.
- Gastric ulcer - in some patients with paraesophageal hernias, the stomach can become twisted, resulting in a specific type of gastric ulcer known as Cameron's erosion. These ulcers can sometimes lead to chronic slow blood loss and anemia.
The tests that can diagnose hiatal hernia are:
- X-ray with barium contrast absorption - This method shows a clear silhouette of the upper digestive tract. In many cases, hiatal hernias are discovered incidentally during chest radiographs on another occasion. If a protrusion is seen through the diaphragm, this indicates the presence of a hiatal hernia, The examination also gives information about the size of the hernial sac and the type of hernia.
- Endoscopy - gives an idea of the patient's condition as soon as the fiberscope passes through the esophagus to the diaphragmatic opening. Fibrogastroscopy also allows to diagnose complications, such as erosive esophagitis, ulcers in the hiatal hernia, tumors.
Treatment
Most cases of hiatal hernias do not require treatment. The presence of symptoms determines what the therapy should be.
Treatment is usually with medication to control acid reflux:
- antacids to neutralise stomach acid
- H2-receptor blockers that reduce acid production
- proton pump inhibitors to prevent acid production
Surgery
If medication does not give the desired result, hiatal hernia surgery may be necessary. However, surgical intervention is not often recommended. To perform surgery, doctors use laparoscopic surgery, which shortens the recovery time of patients.
The stomach gradually moves back into the abdominal cavity. The diaphragm in the esophageal hiatus closes to prevent the stomach from herniating again. In some cases, a special type of mesh is needed to close the diaphragm appropriately and fundoplication is performed. Fundoplication is done to help keep the stomach from herniating back into the chest cavity and to prevent the stomach contents from going back into the esophagus.
Lifestyle changes
Acid reflux causes most hiatal hernia symptoms. Changing diet can reduce symptoms, smaller amounts of food, several times a day instead of three main meals. You should also avoid eating within a few hours of bedtime.
Avoiding certain foods that can reduce the risk of heartburn - spicy foods, chocolate, foods made with tomatoes, caffeine, onions, citrus fruits, alcohol.
Smoking cessation, excess weight management, raising the head high in bed and avoiding bending and lying down immediately after eating, avoiding tight belts and certain abdominal exercises are all effective in reducing symptoms.For more information, we at Medical Carragee are at your service.
Call us on the following numbers "Medical Karaj": 0879 977 401 or 0879 977 402.
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