HIATAL HERNIA
A hiatal hernia is a type of hernia that occurs when the upper part of the stomach that is normally below the diaphragm slides or pushes up through the hiatus into the chest region.
- The diaphragm is a large muscle that lies between the abdomen and the chest.
- The diaphragm has an opening called the hiatus through which the esophagus passes before connecting to the stomach.
- In a hiatal hernia, a portion of the stomach bulges into the chest through that opening.
- A small hiatal hernia may not cause any problem but a large hiatal hernia can cause gastroesophageal reflux disease – a condition in which food and acid back up into the esophagus.
- The most common type of a hiatal hernia is a sliding hiatal hernia. It occurs when the stomach and the section of the esophagus that joins the stomach slides up into the chest through the hiatus. They usually don’t cause any symptoms and may require no treatment.
- A rare form of a hiatal hernia is a paraesophageal hernia. In this type, part of the stomach herniates into the chest alongside the esophagus and stays there. Although this type can occur with no symptoms, the risk is that blood flow to the stomach could become blocked or the stomach can become strangled. This could cause serious damage and is mostly considered a medical emergency.
CAUSES
In most cases, the cause is unknown. A person may be born with a larger hiatus opening or the condition may develop due to injury or other damage that may result in a weakened tissue, this makes it possible for the stomach to bulge through the diaphragm.
It can also be due to age-related changes in the diaphragm
Another possible cause is repeatedly putting too much pressure on the muscles around the stomach. This may result from:
- Violent vomiting
- Hard sneezing
- Straining during bowel movements
- Heavy lifting or bending over
- Frequent or hard coughing
The general risk factors for a hiatal hernia are obesity and being 50 years of age or older
SYMPTOMS
- Heartburn related to GERD
- chest or abdominal pain
- difficulty swallowing
- belching
- shortness of breath caused by the hernia’s effect on the diaphragm
- vomiting of blood
DIAGNOSIS AND TREATMENT
A hiatal hernia is mostly found during a test or procedure to determine the cause of heartburn, chest or abdominal pain.
Several tests can diagnose a hiatal hernia, this may include:
- Barium X-ray. In this test, X-ray is taken after drinking a liquid that coats and fills the inside lining of your digestive tracts. The swallowed barium outlines the stomach, esophagus and upper part of the small intestine.
- Endoscopy, where a thin, flexible tube equipped with light and camera is inserted down your throat, to examine the inside of the stomach and check for inflammation.
- Esophageal manometry, that measures the rhythmic muscle contractions in the esophagus when something is swallowed. It also measures the force that is exerted by the muscles of the esophagus.
TREATMENT
Most people don’t experience any symptoms and may not need treatment. Where symptoms are present, such as acid reflux and recurrent heartburn treatment may be needed including medications, and if those don’t work, surgery.
Medications may include:
- Antacids to neutralize stomach acid. Antacids such as Mylanta, Rolaids may give quick relief.
- H-2-receptor blockers such as cimetidine (Tagamet), famotidine (Pepcid) to reduce acid productions.
- Proton pump inhibitors that block acid production and heal the esophagus.
Surgical options may be used in people with heartburn and acid reflux that don’t improve with medications or people with serious complications. This may include putting the stomach back in place and making the hiatus smaller, removing the hernia sac, or rebuilding weak esophageal muscles.
Surgery is performed either by making a standard incision in the abdomen or chest or using laparoscopic surgery