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Hiatal Hernia: Causes, Types, Symptoms & Treatment

A hiatal hernia occurs when the upper part of the stomach pushes in through the large muscle separating the abdomen and the diaphragm. The diaphragm is a large muscle located between the chest and the abdomen. Normally, the stomach is located below the diaphragm but is different in the case of individuals suffering from hiatal hernia [1] .

In people with a hernia, a portion of the stomach is pushed up through the muscles. The small opening in the diaphragm called the hiatus is through which the upper part of the stomach bulges into the chest [2] . The condition is also termed as stomach hernia [3] .

People who are over 50 years old are most likely to develop this condition. According to the Esophageal Cancer Awareness Association, at least 60% of people develop hiatal hernia by the time they reach age 60 [4] .

Causes Of Hiatal Hernia

Like the various conditions out there with no known specific causes, the cause behind the development of the condition is not known.

In some cases, hiatal hernia can develop as a result of an injury or other damages that can weaken the muscle tissue. As the injury causes the muscle tissue to weaken, this will result in causing the stomach to push through the diaphragm [5] .

The condition can also develop as a result of repeatedly applying too much pressure on the muscles surrounding your stomach. It can happen as a result of straining during bowel movements, coughing, vomiting and while lifting heavy objects [6] [7] .

There are also cases where people are born with an abnormally large hiatus, making it easier for the stomach to be pushed into the diaphragm. Individuals aged 50 or older and people who are obese are at a higher risk of developing hiatal hernia.

Types Of Hiatal Hernia

Generally, the condition can develop in two different types.

1. Sliding hiatal hernia

This is the type of the condition in which the junction of the oesophagus and stomach, and part of your stomach protrudes into the chest cavity. It is termed as sliding hiatal hernia because in these types of hernias, the part of the stomach where the hernia is affected can slide back and forth in the cavity. The hernia slides when you swallow food [8] . Sliding hernias are small in size and usually does not have any symptoms. In most cases, it does not need any sort of treatment either.

2. Fixed hiatal hernia

This type of hernia is not common as compared to the sliding hiatal hernia. It is also termed as a paraesophageal hernia. In fixed hiatal hernia, a part of your stomach is pushed through your diaphragm and it stays there. This type of hernia poses a risk, that is, it can block the blood flow to the stomach - which can cause severe complications[9] . It can also cause food to get stuck in the oesophagus. In severe cases, fixed hiatal hernia requires immediate medical attention [10] .

Symptoms Of Hiatal Hernia

In most cases, the condition develops without the appearance of any signs or symptoms. However, some of the common symptoms include [11] [12]

  • Indigestion
  • Heartburn
  • Hiccuping
  • Regurgitation
  • Belching
  • Nausea and vomiting
  • Bad breath

Complications Of Hiatal Hernia

Although the condition does not pose any risks, if the herniation bulges further into the chest cavity; it can lead to complications such as [13]

  • Vomiting of blood
  • Vomiting progressing to non-productive retching
  • Inability to belch
  • Chest pain after eating
  • Difficulty swallowing (or dysphagia)
  • Upper abdominal pain and distention
  • Sharp chest pain that cannot be treated with antacids
  • Black or tarry stools [14]
  • Shortness of breath (or dyspnea)
  • Oesophageal compression

When To See A Doctor

A hiatal hernia can block the blood flow to your stomach. This obstruction or strangulation caused by the condition requires immediate medical attention.

You must go to a doctor if[13]

  • you are feeling nauseated,
  • you have been vomiting continuously, and
  • you are not able to pass gas or bowels.

Diagnosis Of Hiatal Hernia

Once you go to the doctor to get the severe heartburn or upper abdominal pain checked out, the doctor will carry out some tests to analyse the cause.

1. Upper endoscopy

Under this test, the doctor will insert an endoscope (a thin and flexible tube equipped with a light and camera) down your throat[15] . This is done to examine the insides of your stomach and oesophagus, and to check if there is any possible inflammation.

2. Oesophageal manometry

This test will help in measuring the rhythmic muscle contractions occurring in your oesophagus when you swallow something. Oesophageal manometry will also measure the coordination as well as the force exerted by the muscles in your oesophagus[16] .

3. Barium X-ray

The doctor will ask you to drink a solution made out of a chalky substance called barium. The barium will create a coat and fill the linings of your digestive tract [17] . The white coating will help the doctor to view a silhouette of your oesophagus, upper intestine and stomach.

Treatment For Hiatal Hernia

As in most cases of the condition people do not develop any symptoms, treatment is only a secondary option. However, if you experience signs such as acid reflux or heartburn, you will be required to undergo medication or in severe cases, surgery [18] .

  • Medications to reduce acid production
  • Antacids that neutralize stomach acid
  • Medications that block acid production and heal the oesophagus

In some cases, individuals who do not get any relief from medications will have to undergo surgery. Surgery is required in the case of people who have complications such as narrowing of the oesophagus or severe inflammation [19] .

The surgery will involve pulling your stomach down into your abdomen and making the opening in the diaphragm smaller. This is done by reconstructing the oesophageal sphincter or by removing the hernia sac.

Some of the other surgery options are laparoscopic surgery and thoracotomy.

Home Remedies For Hiatal Hernia

You can control the signs and symptoms of the condition by adopting various lifestyle changes [20] .

  • Avoid foods that trigger heartburn, such as fatty or fried foods, tomato sauce, alcohol, chocolate, mint, garlic, onion, and caffeine.
  • Eat at least two to three hours before bedtime.
  • Eat several smaller meals throughout the day, rather than having large meals in fewer numbers.
  • Avoid lying down after a meal.
  • Maintain a healthy weight.
  • Stop smoking.
  • Avoid alcohol and excessive caffeine.
  • Elevate the head of your bed 6 inches (about 15 centimetres).
  • Avoid wearing tight belts.
  • Do not strain during bowel movements.
View Article References
  1. [1] Wilson, L. J., Ma, W., & Hirschowitz, B. I. (1999). Association of obesity with hiatal hernia and esophagitis.The American journal of gastroenterology,94(10), 2840-2844.
  2. [2] Weyhe, D., & Chowbey, P. (2018). Complex Hiatal Hernias. InLaparo-endoscopic Hernia Surgery(pp. 421-431). Springer, Berlin, Heidelberg.
  3. [3] Memon, M. A., Memon, B., Yunus, R. M., & Khan, S. (2016). Suture cruroplasty versus prosthetic hiatal herniorrhaphy for large hiatal hernia.Annals of surgery,263(2), 258-266.
  4. [4] Hennings, D. L., McLaren, P. J., Mattar, S. G., & Oleynikov, D. (2018). Hiatal Hernia and Reflux Following Bariatric Surgery. InA Mastery Approach to Complex Esophageal Diseases(pp. 49-59). Springer, Cham.
  5. [5] Shih, T. C., Shih, H. H., Chang, Y. T., Dai, Z. K., & Chen, I. C. (2017). Hiatal hernia: A rare cause of iron-deficiency anemia in children.Pediatrics & Neonatology,58(5), 460-461.
  6. [6] Patel, S., Shahzad, G., Jawairia, M., Subramani, K., Viswanathan, P., & Mustacchia, P. (2016). Hiatus hernia: A rare cause of acute pancreatitis.Case reports in medicine,2016.
  7. [7] Oor, J. E., Wiezer, M. J., & Hazebroek, E. J. (2016). Hiatal hernia after open versus minimally invasive esophagectomy: a systematic review and meta-analysis.Annals of surgical oncology,23(8), 2690-2698.
  8. [8] Wallner, B., Björ, O., Andreasson, A., Hellström, P. M., Forsberg, A. M., Talley, N. J., & Agreus, L. (2018). Identifying clinically relevant sliding hiatal hernias: a population-based endoscopy study.Scandinavian journal of gastroenterology,53(6), 657-660.
  9. [9] Montupet, P., & Matta, R. (2017). Hiatal Hernia and Gastroesophageal Reflux. InPediatric Digestive Surgery(pp. 183-191). Springer, Cham.
  10. [10] Pointner, R. (2017). Gastroesophageal Reflux Disease (GERD) and Hiatal Hernia. InSurgical Principles of Minimally Invasive Procedures(pp. 47-51). Springer, Cham.
  11. [11] Parry, K., Brenkman, H. J., Noble, F., van Hillegersberg, R., Sharland, D., Goense, L., ... & Ruurda, J. P. (2016). Hiatal hernia following esophagectomy for cancer.Adenocarcinoma of the gastroesophageal junction: challenges in staging and treatment, 147.
  12. [12] Samakar, K., McKenzie, T. J., Tavakkoli, A., Vernon, A. H., Robinson, M. K., & Shikora, S. A. (2016). The effect of laparoscopic sleeve gastrectomy with concomitant hiatal hernia repair on gastroesophageal reflux disease in the morbidly obese.Obesity surgery,26(1), 61-66.
  13. [13] Oor, J. E., Köckerling, F., Khullar, R., & Hazebroek, E. J. (2018). Complications of Hiatal Hernia Repair and Prevention. InLaparo-endoscopic Hernia Surgery(pp. 415-420). Springer, Berlin, Heidelberg.
  14. [14] Priego, P., De Oteyza, J. P., Galindo, J., Carda, P., García-Moreno, F., Velasco, G. R., & Lobo, E. (2017). Long-term results and complications related to Crurasoft® mesh repair for paraesophageal hiatal hernias.Hernia,21(2), 291-298.
  15. [15] Weijenborg, P. W., van Hoeij, F. B., Smout, A. J., & Bredenoord, A. J. (2015). Accuracy of hiatal hernia detection with esophageal high‐resolution manometry.Neurogastroenterology & Motility,27(2), 293-299.
  16. [16] Ramachandran, V., Shah, K. P., Fishman, D. S., & Chiou, E. H. (2018). Post-fundoplication high-resolution esophageal manometry in a patient with Ehlers-Danlos syndrome.Annals of gastroenterology, 633-633.
  17. [17] Weitzendorfer, M., Köhler, G., Antoniou, S. A., Pallwein-Prettner, L., Manzenreiter, L., Schredl, P., ... & Koch, O. O. (2017). Preoperative diagnosis of hiatal hernia: barium swallow X-ray, high-resolution manometry, or endoscopy?.European Surgery,49(5), 210-217.
  18. [18] Müller-Stich, B., Müller, P. C., Pointner, R., Antoniou, S. A., von Rahden, B. H., & Mittal, S. K. (2018). Techniques of Hiatal Hernia Repair. InLaparo-endoscopic Hernia Surgery(pp. 393-407). Springer, Berlin, Heidelberg.
  19. [19] Siegal, S. R., Dolan, J. P., & Hunter, J. G. (2017). Modern diagnosis and treatment of hiatal hernias.Langenbeck's archives of surgery,402(8), 1145-1151.
  20. [20] Martin, J. V., & Sugawa, C. (2017). Hydrogen peroxide ingestion with injury to upper gastrointestinal tract.World journal of clinical cases,5(10), 378.

Story first published: Thursday, February 21, 2019, 17:19 [IST]
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