Published on Sep 11, 2019 and last reviewed on Oct 03, 2019 - 4 min read
A hiatal hernia occurs when the upper part of the stomach pushes through the diaphragm. Here, in this article, we discussed the types, causes, symptoms, risk factors, treatment options, and preventive measures of hiatal hernia.
When the upper part of the stomach bulges through the diaphragm, which is the large muscle separating the abdomen and chest, it is called hiatal hernia. Here, the stomach pushes up through the opening in the diaphragm called esophageal hiatus. The food pipe passes through the hiatus and gets connected to the stomach.
A hiatal hernia that is small does not need treatment as it does not cause any symptoms. Such hernias are diagnosed accidentally while performing tests for some other condition. But if the hernia is large, it makes food and acid to regurgitate back into the esophagus and results in heartburn. Such hernias might need surgery. It commonly affects people older than 50 years of age.
The two types of hiatal hernia are:
Sliding hiatal hernia - Here, the stomach and esophagus slide in and out of the hiatus. This type of hernia is small and does not need treatment. It is the most common type.
Fixed hiatal hernia - Here, the part of the stomach that is pushed through the hiatus cannot move back and forth and stays fixed. This type of hernia is not common. It can block the blood flow to the stomach, which needs immediate medical attention.
Usually, a hiatal hernia does not cause any symptoms and is often diagnosed incidentally during chest or abdominal X-ray. The symptoms are caused only when acid regurgitates into the esophagus (acid reflux). The symptoms include:
Sour taste in the back of the throat.
Water brash (Excess saliva production due to acid reflux).
Burning sensation in the chest.
Blood in stools or vomit.
These symptoms worsen after eating and lying down. Walking or sitting up helps relieve symptoms.
Usually, the esophageal hiatus is sealed by the phrenoesophageal membrane, which is a thin membrane connecting the esophagus and diaphragm. These membranes need to be elastic to allow the back and forth movement of the esophagus with each swallow. With age and use, these membranes weaken, and a part of the stomach pushes through the membrane, which results in a hiatal hernia.
The exact cause is still not known, but some of the possible causes include:
Increased pressure in the abdominal cavity, which is seen in obese people, pregnant women, etc.
Injury from trauma or surgery.
Lifting heavy objects.
Ascites (abnormal collection of fluid in the abdominal cavity).
Some of the factors that increase the risk of a hiatal hernia are:
It is commonly diagnosed during tests done to diagnose the cause of heartburn or chest pain. The diagnostic tests include:
Barium X-ray - An X-ray of the upper digestive tract is taken after making the patient drink a thick liquid that coats the gastrointestinal lining. This liquid coating makes the doctor identify the esophagus, stomach, and upper intestine in an X-ray.
Endoscopy - Endoscopy is done by inserting an endoscope, which is a thin, flexible tube with a camera at one end, through the mouth into the digestive tract.
Esophageal manometry - This test is used to measure the rhythmic muscle contractions of the esophagus as the patient swallows. It is also helpful in measuring the force exerted by the muscles of the esophagus.
If you experience any of the symptoms mentioned above, it is best to consult a doctor. Sometimes, a fixed hernia can block the blood flow to the stomach, which is a medical emergency. Get immediate medical attention if you notice the following symptoms:
Unable to pass gas.
A hiatal hernia is treated only if you experience signs and symptoms like recurrent heartburn and acid reflux. The treatment options are:
Instead of a few large meals, eat several smaller meals.
Avoid fatty or fried foods.
Avoid drinking coffee or other caffeinated beverages.
Do not consume alcohol.
Do not eat late in the evening or 2 to 3 hours before going to bed.
Avoid lying down immediately after a meal.
Reduce weight if you are overweight.
Keep your head elevated while sleeping.
Antacids - help neutralize stomach acids.
H-2-receptor blockers (Cimetidine and Ranitidine) - reduce acid production.
Proton pump inhibitors (Lansoprazole and Omeprazole) - help block acid production and heal the esophagus.
If your symptoms are not relieved with medications, or if you developed any complication, then surgery needs to be done. During surgery, the stomach is pulled down into the abdomen and the hiatus opening in the diaphragm is made smaller or the esophageal sphincter is reconstructed or the hernia sac is removed.
It might not be possible to prevent a hernia from forming, but you can prevent a hernia from getting worse. The things you can try are:
Maintaining a healthy weight.
Avoid straining while passing stools.
Avoid exercises that strain your abdomen.
Do not wear very tight belts.
Avoid lifting heavy objects.
Treatment is not needed if your hiatal hernia does not cause any symptoms. Simple lifestyle modifications can help with small hernias. Take antacids or any medicine for acid reflux only after consulting your doctor, as indiscriminate use of antacid can result in kidney disease and diarrhea. Consult a doctor online if your symptoms are not getting better even after taking medicines.
Query: Hello doctor, I am having surgery next week for reflux, Nissen fundoplication and hiatal hernia repair. A week before surgery, what can I do to improve my chance of success and limit the chance of complication? Can I take my Nexium (PPI) on the day of surgery or should I stop now? Read Full >>
Answer: Hello, Welcome to icliniq.com. There are no special measures you have to take for the surgery. Just maintain a light and watery diet from a week before surgery. The two last days (especially the last one) you can take any laxatives such as magnesium sulfate to clean and empty your intestine so that ... Read Full
Query: Hi doctor, I am suffering from hiatal hernia. Now, I feel pain in my left hand, shoulder, chest and both sides of the shoulder blade. So, I consulted a cardiologist. He asked me to take an echo and it is normal. Still, I feel pain in the hand while working. When I was a child, I suffered with rheum... Read Full >>
Answer: Hello, Welcome to icliniq.com. Though you suffered from rheumatic fever in childhood, when echo is normal there is no damage to the heart. You must be young with no risk factors like obesity, smoking, family history or diabetes. That is why the further test may not advised by your cardiologist as no... Read Full
Query: Hello doctor, I am a 32-year-old female. I have a right sided bubbling sensation in my chest and that is rhythmic with my pulse. It started today while at rest. I have a history of endometriosis, sensitivities to NSAIDS (gastric ulcers), and iron deficiency anemia. It almost feels like wheezing, bu... Read Full >>
Answer: Hello, Welcome to icliniq.com. In your case, severe anemia can cause blood turbulence while flowing through cardiac valves, which may lead to the sensation of bubbling or flowing fluid. Usually, a murmur can be heard with a stethoscope. Other cause may be just bubbling of gases in the stomach, but... Read Full
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