What is a hiatal hernia?
Any time an internal body part pushes beyond a confining wall into an area where it doesn't belong, it is called a hernia.
The hiatus is an opening in the diaphragm -- the muscular wall separating the chest cavity from the abdomen. Normally, the esophagus (food pipe) goes through the hiatus to drain into the stomach. In a hiatal hernia (also called hiatus hernia) the stomach bulges up into the chest through that opening.
There are two main types of hiatal hernias:
- A sliding hiatal hernia, the junction of the stomach and the esophagus herniate (slide) up into the chest through the hiatus. This is the most common type of hiatal hernia.
- A Paraesophageal hernia is less common, but is more cause for concern. The esophagus and stomach stay in their normal locations, but part of the stomach squeezes through the hiatus, placing it next to the esophagus. Although you can have this type of hernia without any symptoms, the danger is that the stomach can become "strangled," which means its blood supply is cut off.
Often, people with a hiatal hernia also have heartburn or gastroesophageal reflux disease (GERD). Although there is a link, one condition does not necessarily cause the other, because some people can have a hiatal hernia without having GERD, and vice versa.
What causes a hiatal hernia?
In most patients, the cause is not known, but a hiatal hernia is usually the result of many factors. Some people develop a hiatal hernia after sustaining an injury to that area of the body; others are born with a weakness or an especially large hiatus. Some experts suspect that increased pressure in the abdomen from coughing, straining during bowel movements, pregnancy and delivery, or substantial weight gain may contribute to the development of a hiatal hernia.
Who is at risk for hiatal hernia?
Hiatal hernias occur more often in people over the age of 50, in overweight people (especially women), and in smokers.
What are the symptoms of a hiatal hernia?
Many people do not experience any symptoms related to their hiatal hernia.
When symptoms occur, they may be related to gastroesophageal reflux and include heartburn, bitter or sour taste in the back of the throat, bloating and belching, or discomfort or pain in the stomach or esophagus.
Some people with a hiatal hernia may experience chest pain that can easily be confused with the pain of a heart attack. It's important to undergo testing to be properly diagnosed and treated.
If you have been diagnosed with a hiatal hernia, and you have nausea or vomiting; or you are unable to have a bowel movement or pass gas, you may have a strangulated hernia or an obstruction. These are medical emergencies and you should call your doctor immediately.
How is a hiatal hernia diagnosed?
A hiatal hernia can be diagnosed with a barium study, a special X-ray that allows visualization of the esophagus, or with esophagoscopy, a procedure in which the upper digestive system is examined with an endoscope (long-thin flexible instrument).
How are hiatal hernias treated?
Many people do not experience any symptoms related to their hiatal hernia, so no treatment is necessary.
When mild symptoms occur -- such as heartburn, bloating or stomach discomfort -- a hiatal hernia may be successfully treated by making these lifestyle changes:
- Losing weight if you are overweight, and maintaining a healthy weight
- Having a common sense approach to eating, such as eating moderate to small portions of foods; and limiting fatty foods, acidic foods (such as tomatoes and citrus fruits or juices), foods containing caffeine, and alcoholic beverages
- Eating meals at least 3-4 hours before lying down, and avoiding bedtime snacks
- Elevating the head of your bed by 6 inches (this helps allow gravity to keep the stomach's contents in the stomach)
- Taking medications, such as over-the-counter antacids, Gaviscon, or H2 blockers (such as Pepcid AC or Zantac). If you take over-the-counter medications for longer than two weeks without any improvement, see your physician. Your physician may prescribe a stronger medication to manage your symptoms.
If the hiatal hernia is complicated by severe symptoms of GERD or if the symptoms and tests suggest that a paraesophageal hernia (part of the stomach squeezes through the hiatus) may be present, surgery may be recommended.
When is surgery necessary?
Surgery is indicated in patients with a symptomatic hiatal hernia that is present along with these conditions:
- Gastroesophageal reflux or GERD – symptoms include heartburn, regurgitation, dysphagia (difficulty swallowing) that has not been successfully treated with medications
- Strangulated hernia or obstruction – symptoms include early satiety (filling up fast), pain with eating, nausea or vomiting, or inability to have a bowel movement or pass gas.
Hiatal hernia surgery can sometimes be performed with a laparoscopic approach, which is a less-invasive procedure with a faster recovery than traditional hiatal hernia surgery.
After the surgery, there is no guarantee that the hernia will not return, but avoiding abdominal stressors such as heavy lifting and straining, and minimizing weight gain, will reduce the risk of recurrence.