Hiatus hernia

What is a hiatus hernia?

A hiatus hernia is a condition in which a portion of the upper stomach slips through the diaphragm and up into the chest. In individuals with hiatus hernias, the hiatus opening (where the oesophagus goes through the diaphragm) is larger than normal, and a portion of the upper stomach slips through the hiatus.

What are the two different types of hiatus hernias?

  • Sliding hiatus hernias occur when the junction of the oesophagus and stomach, and part of the stomach protrude into the chest, when swallowing.
  • Para-oesophageal hernias occur when part of the stomach passes into the chest beside the oesophagus. The hernia itself remains in the chest at all times, and is not affected by swallowing.

What causes hiatus hernias?

They can be caused by oesophageal hiatus which are bigger than normal. A shortened oesophagus and an abnormally loose attachment from the oesophagus to the diaphragm is also a factor, allowing the oesophagus and stomach to slip upwards. Where people are over-weight (or pregnant) the extra abdominal pressure can cause the oesophagus and stomach to slip upwards.

What are the symptoms of hiatus hernias?

The larger the hernia, the more likely symptoms will feature, including:

  • Heartburn, especially when leaning forward. Here the stomachs contents which contain gastric acid splash up into the gullet or oesophagus and cause a hot painful sensation just under the breast bone.
  • Severe chest pain with difficulty in swallowing, may indicate severe inflammation of the lower oesophagus or that the hernia slid into the chest and became trapped. Immediate medical care is required if this is the case.

How are they diagnosed?

To confirm the diagnosis your doctor may need to perform :

  • An oesophagoscopy, where a viewing tube is inserted down the patient's throat into the oesophagus.
  • An x-ray of the patient swallowing may be required where the hernia appears as a separate sac lying between the oesophagus and the stomach.
  • The doctor may check for heart related pain, to rule out other conditions which mimic symptoms of hiatus hernia.

How is hiatus hernia treated?

Generally hiatus hernias do not require treatment. Eating a balanced diet and not eating before going to bed ease the symptoms. Also not eating and drinking at the same meals helps reduce the volume of the stomach contents and thus reduces episodes of painful acid splashes (heartburn) Losing weight and avoiding tight belts also help prevent symptoms. Where the oesophagus has become inflamed from repeated splashes of gastric acid (Gastro-oesophageal Reflux) treatment with antacids, or acid suppressing medication may be required to reduce the inflammation. Dietary restriction of foods that aggravate the condition (e.g. tea, coffee, alcohol, citrus fruits or chocolate) and stopping smoking may also help.

In severe cases, surgery is required. This involves pulling the stomach down into the abdomen, attaching the oesophagus to the diaphragm, and making the hiatus smaller. However only about 5% of patients require surgery.

How can I prevent hiatus hernia?

It is difficult to prevent it. But taking a few precautionary steps, may reduce your risk of the condition:

  • Maintaining a healthy diet, and avoiding smoking.
  • Avoid abdominal strain.
  • Request stool-softening medication if you frequently need to strain when you move your bowels.

However those with a hiatus hernia can avoid painful symptoms of Gastro-oesophageal Reflux by following the advice above.

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