About Hiatus Hernia
A hiatus hernia happens when the stomach or other organs in the abdomen push through a gap in the diaphragm (the muscle that separates the chest from the abdomen) called the esophageal hiatus. This causes part of the stomach to bulge up into the chest. There are different types of hiatus hernias:
- Sliding hernias (Type I): Here, the place where the esophagus meets the stomach slides up into the chest.
- Paraesophageal hernias (Types II-IV): In these types, part of the stomach pushes up next to the esophagus.
Hiatus hernias may not cause symptoms, but they can sometimes lead to chest pain, trouble swallowing, shortness of breath, and heartburn. For hernias that cause symptoms or certain types, surgery may be an option. The surgery usually involves moving the hernia back into place, removing the hernia sac, and tightening the top part of the stomach (a procedure called fundoplication) to prevent acid reflux.
A hiatus hernia happens when part of the stomach pushes up through the diaphragm, the muscle that separates the chest from the abdomen. The reason for this weakness in the diaphragm isn’t completely understood.
Non-modifiable risk factors for a hiatus hernia cannot be controlled or changed. They include:
- Age: Hiatus hernias are more common in people over 50.
- Genetics: Some people may have a higher risk of hiatus hernia due to their genes.
Modifiable risk factors for a hiatus hernia can be influenced by individual habits and lifestyle. They include:
- Obesity: Extra weight can put more pressure on the diaphragm, increasing the risk of a hernia.
- Straining: Straining from heavy lifting or during bowel movements can raise abdominal pressure, which may contribute to a hernia.
- Pregnancy: A growing baby can push the stomach up, causing a hiatus hernia in some women.
- Frequent coughing or vomiting: Both can increase pressure in the abdomen, which might lead to a hernia over time.
While these factors can increase the chances of developing a hiatus hernia, they don’t guarantee it will happen. If you’re concerned about your risk, talk with a healthcare provider for personalized advice.
The most common early symptoms of hiatus hernia include:
- A bulge or lump in the affected area, which may disappear when lying down and become more visible when coughing, standing up, or bending down.
- Discomfort in the area around the bulge
As hiatus hernia progresses or reaches higher severity, other common symptoms may occur:
- Acid reflux, where stomach acid moves backward into the esophagus causing a burning sensation.
- Chest pain
- Difficulty swallowing
- Bloating
- Belching
- Pain
- Bitter taste in the throat
It is important to note that some hernias may have no symptoms at all. If you suspect you have a hernia or experience any of these symptoms, it is best to consult with your healthcare professional for an accurate diagnosis and appropriate treatment.
To diagnose hiatus hernia, doctors commonly perform the following examinations, tests, and procedures:
- Endoscopy: A thin, flexible tube with a camera is gently passed down the throat to examine the esophagus. This helps doctors see if part of the stomach is pushing up through the diaphragm.
- Manometry: A thin tube is inserted through the nose and down the esophagus to measure muscle pressure and check how well the esophagus muscles and valve at the stomach opening are working.
- pH Monitoring: This test measures acid levels in the esophagus to check for acid reflux. A small probe is placed above the hiatus (the opening in the diaphragm) to see if stomach acid is moving up.
- Esophagogram (Barium Swallow Test): In this X-ray test, you swallow a liquid barium solution. The barium coats the esophagus, helping doctors watch how it moves food down to the stomach.
To check the stage or severity of a hiatus hernia, doctors may recommend additional tests:
- Imaging tests: X-rays or ultrasounds provide a view of the hernia’s size and position.
- CT scan: This scan uses a contrast dye (either taken as a drink or injected) to create detailed images of the hernia and nearby blood vessels.
- MRI scan: This test uses magnetic fields and radio waves to make clear images of soft tissues, like the diaphragm and surrounding organs.
Remember, these are general descriptions, and specific recommendations may vary depending on individual circumstances. It is important to consult with your healthcare professional for personalized advice regarding examinations, tests, and procedures for diagnosing and determining the stage or severity of hiatus hernia.
The goals of treatment for hiatus hernia are to alleviate symptoms and prevent complications. Here are the different treatment options and how they work to achieve these goals:
- Medications: Doctors may prescribe proton pump inhibitors (PPIs), which reduce stomach acid. Less acid helps ease reflux symptoms and allows the esophagus to heal.
- Lifestyle changes: Certain habits can help lower reflux symptoms, like eating smaller meals, avoiding fatty and acidic foods, and raising the head of the bed to prevent reflux at night.
- Surgery: For large or troublesome hernias, surgery may be needed to move the stomach back into place and strengthen the diaphragm, reducing the chance of future hernias.
- Healthy habits: Maintaining a healthy weight, quitting smoking, and limiting alcohol can help manage symptoms and lower the risk of problems from a hiatus hernia.
Each of these treatment options works towards achieving the goals of reducing symptoms, preventing complications, and improving quality of life for individuals with hiatus hernia. Remember to consult with your healthcare professional to determine the most appropriate treatment plan for your specific condition.