- Causes: Hiatus hernia occurs when the upper part of the stomach bulges through the diaphragm into the chest cavity. The exact cause is not always clear but factors like age, obesity, and smoking can increase the risk .
- Presentation: Typical symptoms include heartburn, regurgitation, chest pain, difficulty swallowing, and feeling full despite eating little. Some people may not have symptoms, while others may experience complications like gastroesophageal reflux disease (GERD).
- Investigation: Diagnosis involves imaging tests such as barium swallow, endoscopy, and pH monitoring to visualize the hernia and assess its severity. These tests help differentiate hiatus hernia from other conditions with similar symptoms.
- Diagnosis: Clinical presentation, along with imaging studies and endoscopic evaluation, aids in diagnosing hiatus hernia. Symptoms, such as heartburn and regurgitation, coupled with imaging findings, confirm the diagnosis.
- Treatment: Management options include lifestyle changes, medications to reduce acid reflux, and in severe cases, surgery to repair the hernia. Lifestyle modifications may involve weight loss, dietary adjustments, and avoiding trigger foods. Medications like proton pump inhibitors (PPIs) and antacids can alleviate symptoms.
The diaphragm is a muscular wall that separates the abdomen from the chest. In hiatal hernia part of the stomach protrudes upward into the chest through an esophageal opening in the diaphragm. Any internal organ that pushes itself into another area of the body is called a hernia. The esophagus goes through the hiatus and then meets with the stomach. The stomach bulges up through that opening and this condition is called hiatus hernia.
Causes of Hiatal Hernia
There are two types of hiatus hernia: para-esophageal hernia and sliding hiatal hernia.
Para-esophageal hernia
In this condition, the stomach and esophagus locations are undisturbed. Part of the stomach actually pushes itself upward through the hiatus and lodges itself next to the esophagus. Blood supply to the stomach is strangled.
Sliding hiatal hernia
This hernia is very common. The stomach and the part of the esophagus both together slide up into the chest area.
Hiatal or hiatus hernia can be caused by:
- Congenitally large hiatu
- Injury to the area
- Immense and continuous pressure while vomiting, straining during bowel movement, lifting heavy objects and chronic coughing
- Advanced age – because at such an age the diaphragm muscle weakens
- Indigestion or dyspepsia
Hiatal Hernia Symptoms
- Acid reflux symptoms : the sphincter muscle does not work normally and the pressure of the diaphragm muscle on the esophagus is lost
- Heart burn: a burning feeling emerges from the abdomen or upper stomach to the lower chest area and into the neck
- Pain in upper abdomen and chest
- Acidic taste in the mouth
- Feeling bloated in the stomach
- Excessive belching
- Unable to swallow hot drinks due to burning pain in the stomach
- Persistent coughing at night due to reflux acid irritating the trachea
- Asthma symptoms
- Gum problems and bad breath
- Hoarseness
- Feeling of lump in the throat
- Severe chest pain
Hiatus Hernia Diagnosis
X-ray study
A barium swallow followed by an x-ray allows examination of the esophagus and stomach.
Endoscopy or Gastroscopy
An endoscope is inserted into the gullet to examine the esophagus for any abnormalities.
Esophageal Manometry Test
This is a pressure study which checks the strength and muscle coordination of the esophagus whilst swallowing.