Hiatal Hernia: Symptoms and Treatment

Diaphragm is a muscular dome which separates your lungs cavity from stomach. It has a small opening(hiatus) through which food pipe(esophagus) passes which connects your mouth to the stomach. Hernia is a condition where your internal body part bulges into an area where it doesn’t belong. In hiatal hernia, part of your stomach bulges into the chest cavity through the opening of the food pipe. Many people with small hiatal hernia have no symptoms and are found incidentally during a chest x-ray but large hiatal hernia can be symptomatic as heartburn or chest pain.

This condition is common in children and generally occurs in people over 50 years of age.

Symptoms and Signs of Hiatal Hernia

Most of the hiatal hernia have no symptoms at all and if symptoms arise these are usually caused by the stomach acid and bile or air entering the esophagus. It includes

1. Heartburn
2. Chest pain or epigastric pain
3. Difficulty in swallowing
4. Blood in vomiting
5. Passing black stools
6. Regurgitation of food and liquid
7. Shortness of breath

Causes of Hiatal Hernia

Physicians think that the hiatal hernia occur due to weakening of the muscles of the diaphragm, which allows the stomach to herniate through from that opening when the pressure around your stomach increases during

• Vomiting
• Coughing
• Lifting heavy objects
• Excessive straining during bowel movements

Trauma due to injury or surgery in this area can also lead to hernia

Some children are born with an abnormal large hiatus. So, they are at high risk of having hiatal hernia

Risk factors for Hiatal Hernia

Population studies have shown that the hiatal hernia is most common in the patient who

• Are women
• Overweight
• Age older than 50

Complications of Hiatal Hernia

Sometimes hernia becomes strangulated means the blood supply to the hernia is blocked. This is a medical emergency and need to consult to your doctor if you feel nauseated or discomfort in the abdomen

Diagnosis of Hiatal Hernia

Most of the hiatal hernia are discovered during the routine chest x- ray or endoscope done for the upper digestive tract. The medical history can only be suggestive of problems in the upper digestive tract and your doctor will always order some tests to find the cause of the problem and these tests includes

Barium swallow: The patient is given a liquid to drink which contains barium compound that coats the lining of the digestive tract. The fluid is visible on the X- ray and therefore only that part of tract is visible where fluid is reached. It can be used to know the type and position of the defect.

Upper endoscopy: Endoscope is a flexible tube with a camera and light. It is inserted in to your upper digestive tract through your mouth to look for any problems in the esophagus or stomach.

Your doctor can suggest some more tests if the findings are associated with other medical conditions like GERD or Barrett’s esophagus.

Treatment of Hiatal Hernia

As you already know that the most of the cases are symptomless and don’t require treatment. The symptomatic cases are treated accordingly first by medications and if not cured then by surgery

Medications

Heart burn is due to reflux of the acid from the stomach into the esophagus and medications includes

• Over the counter antacids which neutralizes the acid
• H2 blocker which decreases the secretion of the acid
• Potassium pump inhibitor are the drugs that are strong inhibitor of acid production.

Surgery

Not all cases of symptomatic hiatal hernia can be treated by the medications. Some hiatal hernia especially larger ones require surgery which have developed some complications like severe inflammation or narrowing of the esophagus.

• The surgery includes making an incision in the chest or using a laparoscope and includes
• Rebuilding the weak muscles of diaphragm
• Reversing the herniation and making the hiatus small

Resources:

• American Gastroenterological Association
• Kahrilas PJ. Hiatus hernia
• Jackson FW. (2012). Hiatal hernia
• Hiatal hernia. (n.d.)