The hiatal hernia is a condition in which part of the stomach pushes through a gap between the chest and abdomen, the diaphragm. Through the esophagus (the tube that connects the mouth to the stomach), the diaphragm has a small hole called the hiatus. A stomach normally sits under the diaphragm, but can sometimes bulge up into the chest through the hiatus in some cases. Symptoms and complications can include acid reflux, heartburn, chest pain, difficulty swallowing, and bleeding.
The exact cause of hiatal hernia is not known, but it may be due to several factors, such as:
Age: As people get older, the diaphragm may weaken and allow the stomach to move up.
Pressure: Increased pressure in the abdomen due to pregnancy, obesity, coughing, straining, or lifting heavy objects may force the stomach through the hiatus.
Injury: Trauma or surgery to the chest or abdomen may damage the diaphragm and create a larger opening for the stomach.
Congenital: Some people may be born with a larger hiatus or a weak diaphragm that makes them more prone to developing a hiatal hernia.
There are two main types of hiatal hernia:
Sliding hiatal hernia: This is the most common type, where the stomach and the lower part of the esophagus slide up and down through the hiatus. This type of hiatal hernia may not cause any symptoms or require any treatment.
Paraesophageal hiatal hernia: This is a less common but more serious type, where the stomach pushes through the hiatus and stays there, next to the esophagus. This type of hiatal hernia can cause the stomach to twist or become trapped, which can cut off its blood supply and lead to serious complications.
Many people with hiatal hernia do not have any symptoms or only have mild ones. However, some people may experience:
Heartburn: A burning sensation in the chest or throat caused by stomach acid flowing back into the esophagus. This can worsen after eating, lying down, bending over, or exercising.
Regurgitation: The feeling of food or liquid coming back up into the mouth or throat.
Dysphagia: Difficulty swallowing food or liquids due to narrowing or obstruction of the esophagus.
Chest pain: A sharp or dull pain in the chest that may radiate to the back, neck, jaw, or arms. This can be confused with a heart attack or angina.
Shortness of breath: Difficulty breathing due to pressure on the lungs from the herniated stomach.
Nausea and vomiting: Feeling sick or throwing up due to irritation or inflammation of the esophagus or stomach.
Anemia: A low level of red blood cells due to bleeding from ulcers or erosions in the esophagus or stomach.
To diagnose a hiatal hernia, a doctor may perform one or more of the following tests:
Physical exam: The doctor may feel for a bulge in the abdomen or listen for abnormal sounds in the chest.
X-ray: The doctor may take an X-ray of the chest and abdomen to see if there is any displacement of the stomach or other organs.
Endoscopy: The doctor may insert a thin tube with a camera and light (endoscope) through the mouth and into the esophagus and stomach to look for signs of hiatal hernia, inflammation, ulcers, or bleeding.
Barium swallow: The doctor may ask the patient to swallow a liquid containing barium (a contrast agent) that coats the esophagus and stomach and makes them visible on an X-ray.
Esophageal manometry: The doctor may insert a thin tube with sensors (manometer) through the nose and into the esophagus to measure the pressure and movement of the muscles in the esophagus.
The treatment of hiatal hernia depends on its type, size, symptoms, and complications. Some possible treatments are:
Lifestyle changes: The doctor may advise the patient to make some changes in their habits and diet to reduce pressure on the abdomen and prevent acid reflux. These include:
Losing weight if overweight or obese
Avoiding smoking and alcohol
Eating smaller and more frequent meals
Avoiding spicy, fatty, acidic, or caffeinated foods
Elevating the head of the bed by 6 inches
Waiting at least 3 hours after eating before lying down or sleeping
Wearing loose-fitting clothes
Medications: The doctor may prescribe some medications to reduce the production or neutralize the effect of stomach acid, such as:
Antacids: These are over-the-counter drugs that can relieve mild heartburn by neutralizing stomach acid.
H2 blockers: These are drugs that can reduce the amount of acid produced by the stomach, such as ranitidine, famotidine, or cimetidine.
Proton pump inhibitors: These are drugs that can block the enzyme that makes acid in the stomach, such as omeprazole, lansoprazole, or esomeprazole.
Surgery: The doctor may recommend surgery to repair the hiatal hernia if it is large, causes severe symptoms, or leads to complications. There are different types of surgery, such as:
Nissen fundoplication: This is the most common type of surgery, where the surgeon wraps the upper part of the stomach around the lower part of the esophagus and stitches it in place. This creates a valve that prevents acid reflux and restores the normal position of the stomach.
Paraesophageal hernia repair: This is a type of surgery where the surgeon pulls the stomach back into the abdomen and closes the opening in the diaphragm. This prevents the stomach from twisting or becoming trapped and restores its blood supply.
LINX device: This is a type of surgery where the surgeon implants a ring of magnetic beads around the lower part of the esophagus. The beads help keep the esophagus closed when not swallowing and allow it to open when swallowing. This prevents acid reflux and preserves the normal function of the esophagus.
There is no sure way to prevent hiatal hernia, but some measures that may help reduce the risk or delay its onset are:
Maintaining a healthy weight
Avoiding smoking and alcohol
Eating a balanced and nutritious diet
Exercising regularly
Practicing good posture
Managing stress
Seeking medical attention for any symptoms or complications
