Hiatal hernia

Overview

A hiatal hernia is a common anatomical abnormality in which part of the stomach protrudes or herniates through the diaphragm and up into the chest. If the stomach gets stuck in the defect in the diaphragm, the hernia may become confined and cause severe pain in the chest and abdomen, which is a surgical emergency. Complications may include pulmonary (lung) aspiration, slow bleeding and iron deficiency anemia (for large hernias), and strangulation (closing off) of the hernia.

Symptoms

A hiatal hernia alone seldom causes symptoms. Pain and discomfort are due to the upward flow of stomach acid, air or bile. Occasionally, the pressure of the hernia on the lungs may cause shortness of breath. The regurgitation of acidic fluids into the throat may cause aspiration into the lungs, inciting asthma or even pneumonia. Other symptoms are chest pain, heartburn (worse when bending over or lying down) and difficulty in swallowing.

 

Treatment

Hiatal hernia is most often treated with oral medications to control the stomach and strengthen the lower esophagus muscles that keep stomach contents from backing up. A gastroenterologist will likely prescribe medicine to diminish the amount of acid produced in the stomach. If this does not relieve symptoms, surgical therapy may be needed. Surgery for this condition is designed to reduce the protruding part of the stomach back into the abdomen.

 

Types

There are four types of hiatal hernias:

Type I: commonly referred to as the sliding hiatal hernia. This is the most common case and it occurs when the area where the esophagus and stomach meet (gastroesophageal junction) protrudes through the chest.

The following types occur when a portion of the stomach pushes up into the chest adjacent to the esophagus:

Type II: paraesophageal hiatal hernia, occurs when the upper portion of the stomach moves upward beyond the cardia (where the esophagus and stomach meet)

Type III: combined hernias when the upper portion of the stomach and the cardia move upward

Type IV: when the stomach and additional organs herniate through the chest.

The vast majority of hiatal hernias are called a type I or sliding hiatal hernias. In this type, the stomach intermittently slides up into the chest through a small opening in the diaphragm. Types II, III, and IV hiatal hernias are called paraesophageal hernias.

Causes

The exact cause of hiatal hernias is unknown, but they may be due to weakness of the supporting tissue.

Prevention

  • Quit smoking.
  • Avoid overeating.
  • Do not lie down, bend over or go to bed right after a meal. Instead, wait a couple of hours.
  • Lose weight, if necessary.
  • Elevate the head of your bed six inches by placing bricks or cinderblocks under its legs.

Diagnosis

Tests used to diagnose a hiatal hernia are:

  • Barium swallow X-ray
  • Esophagogastroduodenoscopy (EGD)

Risk factors

Age, obesity and smoking are the biggest risk factors. The problem often occurs in people over 50 years old. Children with this condition are usually born with it (congenital). In infants, it often is accompanied by gastroesophageal reflux.

 

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