Hiatus Hernia

A hiatal hernia occurs when the stomach or any other internal organ bulges out in the chest cavity through an opening in the chest. Hiatus is an opening through the diaphragm through the oesophagus, called a hiatal hernia.1 Although hiatus hernia may be asymptomatic, it can cause heartburn, chest pain, and acid reflux.

A hiatal hernia does not always cause problems, and many people may be unaware they are suffering from a hiatal hernia until they accidentally go for a diagnosis. However, larger hiatal may lead to complications.

A hiatal hernia may not always be symptomatic or cause issues. Many people may be unaware that they are suffering from this condition until it is incidentally discovered. However, larger hiatal hernias may lead to increased symptoms and complications.

Causes of Hiatal Hernia

A hiatal hernia occurs because the hole in the diaphragm increases and weakens, which allows bulging out of the stomach. Hiatal hernia can be caused by the following:

  • Age-related changes in the hiatus and diaphragm
  • Hereditary large hiatus opening
  • Any trauma, injury, or surgical complications
  • Exercise, obesity, chronic cough, and constant pressure on diaphragm muscles weaken it, which may lead to hiatal hernia.

Aged people (above 50) and obese are more susceptible to getting hiatal hernia. Almost 60% of the world population above 60 is affected by hiatal hernia.

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Types of Hiatus Hernia

Sliding hiatus hernia

This is the most common type of hiatal hernia in which a portion of the stomach slides back and forth with respiration. It is a less problematic and asymptomatic hernia.

Fixed hiatus hernia

In this hiatal hernia, the upper part of the stomach is caught up and fixed in the chest. This type is associated with mild to moderate symptoms.

Serious hiatus hernia

This is a complicated type of hiatal hernia in which the entire stomach moves up in the chest. This hiatal hernia type is associated with complex symptoms, and it may require surgical procedures.

Symptoms

Initially, a hiatal hernia can be asymptomatic. This is especially true of sliding hiatal hernias, which typically only causes mild acid reflux and heartburn. Such symptoms do not lead to a diagnosis until the condition worsens. The following symptoms may be present2:

  • Chest pain
  • Heartburn from gastroesophageal reflux disease
  • Trouble swallowing
  • Bad taste in your mouth
  • An upset stomach and vomiting
  • Bloating
  • Burping
  • Shortness of breath
  • Backflow of food and liquid from the stomach into the mouth

Can a hiatus hernia cause indigestion and pain?

A hiatal hernia does not normally cause acute pain and indigestion. A hiatal hernia may lead to acute pain, but not all indigestions and acute pains indicate a hiatal hernia. Indigestion may be due to other conditions like peptic ulcers and coronary diseases.

Diagnosis

As the symptoms do not diagnose the hiatal hernia differently from other conditions, the following methods can be applied to confirm the diagnosis.3

Barium swallow: helps visualize the oesophagus and chest area after swallowing it.

Endoscopy: a long tube that shows the internal parts of the oesophagus and diaphragm.

Oesophagal manometry: helps detect the pressure inside the oesophagus when you swallow the food.

pH test: helps in detecting the acid levels in the oesophagus.

Treatment

Initially, symptomatic treatment is required, which means the physician may prescribe medication according to the severity of the symptoms.

  • Antacids neutralize the stomach acid.
  • Proton pump inhibitors and H2 blockers decrease the acid production.
  • Other medicines like intestinal antispasmodics, calcium channel blockers, and some antidepressants weaken the muscle strength of the lower oesophagus.

Eat smaller and more frequent meals compared to overeating. Avoid foods that may aggravate acid production and acid reflux into the oesophagus such as:

  • nicotine (cigarettes)
  • spearmint
  • caffeine
  • peppermint
  • alcohol
  • chocolate
  • fatty foods
  • Elevate the head of the bed around 8-10 inches to avoid the backflow of food after eating.

Surgery

Serious and complex cases require modern surgery as a last resort for patients who show no response to medications.4

Summary

Hiatal hernia is a common and underrated condition that is mostly asymptomatic but can lead to complications. A physician can diagnose and chalk out a plan to treat the condition.

References

  1. Smith RE, Shahjehan RD. Hiatal Hernia. StatPearls. Published online January 14, 2022. Accessed June 9, 2022. https://www.ncbi.nlm.nih.gov/books/NBK562200/
  2. Sfara A, Dumitrascu DL. The management of hiatal hernia: an update on diagnosis and treatment. Med Pharm Reports. 2019;92(4):321. doi:10.15386/MPR-1323
  3. Hyun JJ, Bak YT. Clinical Significance of Hiatal Hernia. Gut Liver. 2011;5(3):267. doi:10.5009/GNL.2011.5.3.267
  4. Siegal SR, Dolan JP, Hunter JG. Modern diagnosis and treatment of hiatal hernias. Langenbeck’s Arch Surg. 2017;402(8):1145-1151. doi:10.1007/S00423-017-1606-5

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