Hiatus Hernia

Hiatus hernia or hiatal hernia is the protrusion of the upper part of the stomach into the thorax through a tear or weakness in the diaphragm.

The diaphragm is a flat sheet of muscle tissue that separates the lungs from the abdomen.

Most hernias pose no major problems. In the most severe cases, surgery is recommended.

The surgery can have minor side effects such as increased production of stomach and intestinal gas.

Causes of Hiatal Hernia

Possible causes or contributing factors for having a hiatal hernia are:

  • Obesity
  • Exercises such as weightlifting
  • Poor seated posture (such as slouching)
  • Frequent coughing
  • Straining with constipation
  • Frequent bending over or heavy lifting
  • Heredity
  • Smoking
  • Congenital defects

    Types of Hiatal Hernia

  • Sliding Hiatus Hernia: This most common type of hiatus hernia. The herniated portion of the stomach slides into and out of the chest. These hernias are small and usually cause no symptoms.
  • Fixed Hiatus Hernia: In this type of hernia, the upper part of the stomach is caught up in the chest. It may cause few symptoms and poses potential problems in the esophagus.
  • Serious Hiatus Hernia: This type of hernia is uncommon. In some cases, the entire stomach moves up in the chest. Medical problems are likely to occur with this hernia. Treatment is surgery and it is required.

    Symptoms of Hiatal Hernia

    Some hiatus hernias, especially sliding hernias cause no symptoms in some patients. For others, symptoms may include:

  • Heartburn
  • Regurgitation
  • Acid Reflux
  • Anaemia and Strictures may result from chronic inflammation of the lower oesophagus

    Hiatal hernias do not cause indigestion.

    Hiatus Hernia Diagnosis

    The hiatal hernia diagnosis is usually made through an upper gastrointestinal barium x-ray or by gastroscopy.

    Upper-intestinal endoscopy may also be done. In the latter process, the patient is lightly sedated then the physician visually examines the esophagus and stomach using a flexible scope.

    Hiatus Hernia Treatment

    Patients who experience the symptoms of hiatal hernia should elevate the head of their beds. They should also avoid lying down immediately after meals. Overweight patients need to lose weight.

    Medications that lower the lower esophageal sphincter (LES) pressure should be avoided.

    Antisecretory drugs like proton pump inhibitors and H2-receptor blockers can be used to reduce acid secretion. Patients may also be prescribed acid blocking medications. These include Zantac, Tagamet, Axid, Pepcid, Prevacid, Prilosec, Aciphex, Protonix and Nexium etc.

    Endoscopic plication or radio frequency energy delivery to the LES may be considered.

    If these options are ineffective, surgery should be considered. Surgery usually consists of nissen fundoplication. The nissen fundoplication surgery is usually successful in eradicating the symptoms.

    Hiatus Hernia Complications

    The hiatal hernia condition promotes reflux of gastric contents. It is therefore associated with gastro-esophageal reflux disease (GERD) or acid reflux.

    It is also associated with all the likely consequences of GERD such as heartburn, esophagitis, Barretts oesophagus and oesophageal cancer.

    Anaemia may result due to chronic bleeding from the lower oesophagus. When stomach secretions seep up the oesophagus and into the lungs, this can result in chronic cough, wheezing, and even pneumonia.

    In addition to discomfort from reflux and difficulty swallowing, hiatal hernias can have severe consequences on the patient if not treated. The complicated hernias can cause grave problems such as difficulty in breathing and severe chest pain. The elderly are particularly prone to this.

    Sliding hernias are associated with gastroesophageal acid reflux. Serious hernias can strangulate a portion of the stomach above the diaphragm.

    This strangulation can result in esophageal or GI tract obstruction, even become ischemic, and necrose.

    Hiatus Hernia Diet

    Some foods are associated with aggravating the symptoms of hiatal hernia. It is advisable to avoid:

  • Hot foods and drinks
  • Spicy foods
  • Acidic foods
  • Foods that are difficult to digest
  • Smoking
  • Alcohol

    Generally an acid reflux diet should be considered. See;

  • Acid Reflux

  • Acid Reflux Diet & Treatment

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