Hiatal Hernia

A Hiatal hernia usually occurs when the upper part of your stomach pushes up into your chest region. A slight hiatus opens in your diaphragm, from which the oesophagus connects with your stomach. When the patient has a small hiatal hernia, he doesn’t face any symptoms until the disease is mild. While when the condition turns severe into a large hiatal hernia, it turns food along with acid moving back into the oesophagus, leading to heartburn. Doctors efficiently treat this disease in the initial stages with medication and lifestyle changes, but it may require surgical treatment when the condition becomes severe.

Types: There are two types of hiatal hernia:

  • Sliding Hiatal Hernia: As the name indicates, a sliding hiatal hernia occurs when the stomach and oesophagus slide through the hiatus into and out of your chest. It is the most common type of hiatal hernia. It is small, usually has no symptoms, and does not require any treatment.
  • Fixed Hiatal Hernia: Fixed Hiatal hernia is also known as a paraesophageal hernia. In this type, a part of your stomach pushes out through the diaphragm, unable to return to its normal position. This type of hiatal hernia is not common and is associated with a risk of blocking stomach blood flow. This condition is severe, and the patient must take immediate medical help. 

Causes:

Hiatal hernia is usually caused by weakened muscle tissue that initiates the muscle to bulge through the diaphragm. There isn’t any apparent reason behind this disease, but the following conditions may cause it:

  • If you are born with a significant hiatus.
  • Changes in your diaphragm due to aging.
  • Pregnancy.
  • Any Injury in your stomach or diaphragm after surgery or trauma.
  • Continuous muscle pressure during coughing, vomiting, exercising, lifting heavy objects, and strain bowel movement.

Symptoms:

A small hiatal hernia usually does not cause any signs and symptoms, but in a fixed hiatal hernia, the patient might feel like;

  • Abdominal pain
  • Chest pain
  • Difficulty in swallowing
  • Heartburn
  • Acid reflux disease (backflow of acid into the oesophagus)
  • Shortness of breath 
  • Feel full (immediate after eating)
  • Regurgitation of liquid and food particles into your mouth
  • Black stool and blood in vomiting due to gastrointestinal bleeding

When to see a doctor?

Hiatal hernia causes excessive damage to your body when the disease turns severe. Get immediate medical help if you notice any of the symptoms mentioned above in your body. 

Diagnosis:

During diagnosis, your doctor may be asked about your medical history and symptoms. After a small physical trial, he may order the following test to diagnose the reason behind heartburn and chest pain:

  • Upper Digestive System X-ray: In an X-ray of the digestive tract, the doctor asks you to drink a chalky liquid that coats the inside lining of your digestive tract. With the help of this coating, the doctor quickly diagnoses the silhouette of your oesophagus, stomach, and upper intestine.
  • Oesophageal Manometry: This test measures the rhythmic muscle contraction of the oesophagus during swallowing. It helps to diagnose the coordination and force exerted through your oesophageal muscles.
  • Upper Endoscopy: The doctor inserts a thin, flexible tube into your throat during an upper endoscopy. It helps check inflammation and internal condition of your stomach and oesophagus.
  • PH test: A pH test is used to determine the level of acid in the oesophagus and its symptoms. 

 

Treatment:

In the mild stage of hiatal hernia, it usually doesn’t require any treatment; however, when it turns severe, the patients feel acid reflux and heartburn symptoms. The doctor may prescribe lifestyle changes, medication, and surgery to treat this condition. 

  • Lifestyle changes: In hiatal hernia, the doctor may recommend the following lifestyle changes for treatment:
  • Maintain a healthy weight
  • Avoid acidic foods such as citrus fruits juice or tomato sauce
  • Decrease the portion size of your meal
  • Avoid bedtime snacks
  • Eat food 2 to 3 hours before going to bed
  • Avoid smoking
  • Avoid wearing tight clothes or tight belts that put pressure on the abdomen
  • Use proper medication to reduce acidity in the stomach
  • Use two pillows to keep your head at least six inches high from the rest of your body while lying
  • Limit the use of fast food, fried food, caffeine, beverages, ketchup, and vinegar in your diet
  • Medication: The doctor may prescribe the following medicines for heartburn and acid reflux:
  • Antacids used to neutralize stomach acid: Rolaids, Tums, and Mylanta are the Antacids used to balance the stomach acid. It helps to get quick relief but also has side effects, such as diarrhea and kidney problems.
  • Medications used to reduce acid production: H-2 receptor blockers, including cimetidine (Tagamet HB), Nizatidine (Axid AR), and famotidine (Pepcid AC), are usually recommended by doctors to reduce acid production in the stomach.
  • Medications used to heal the oesophagus and block acid production: H-2 receptor blockers and over-the-counter medication such as lansoprazole (Prevacid 24HR) and Omeprazole (Prilosec, Zegerid) are known as proton pump inhibitors. They allow the oesophagus to heal and block acid production.

  • Surgery:  In severe cases, surgical treatment is required to treat hiatal hernias. Doctors recommend surgery if medication and lifestyle changes can’t treat the diseases. If the condition gets complicated, it may cause severe inflammation and narrowing of the oesophagus. In surgery, the surgeon pulls that part of the stomach down to your abdomen, making the diaphragm’s opening smaller. In this process, the doctor will reconstruct your oesophageal sphincter. Sometimes, hiatal hernia surgery is combined with a weight loss surgery such as sleeve gastrectomy. This surgery usually involves a single incision in your chest wall or laparoscopy, a minimally invasive technique. In laparoscopic surgery, the doctor inserts a surgical tool and a tiny camera into the patient’s abdomen and operates with the help of view displays on a video monitor. 

Risk factors: Following factors increase the risk of hiatal hernia:

  • Overweight
  • Obesity
  • Pregnancy
  • Excessive use of fast food, alcohol, and caffeine
  • Use of tight clothes
  • Having bedtime snacks

 

References:

  • https://www.mayoclinic.org/diseases-conditions/hiatal-hernia/diagnosis-treatment/drc-20373385 
  • https://www.mayoclinic.org/diseases-conditions/hiatal-hernia/symptoms-causes/syc-20373379#:~:text=A%20hiatal%20hernia%20occurs%20when,abdomen%20and%20chest%20(diaphragm)
  • https://my.clevelandclinic.org/health/diseases/8098-hiatal-hernia 
  • https://www.webmd.com/digestive-disorders/hiatal-hernia 
  • https://www.healthline.com/health/hiatal-hernia

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