Hiatal Hernia
Also known as: Hiatus hernia or diaphragmatic
hernia
What is it?
A hernia is the protrusion of an organ through the
wall that normally contains it. With a hiatal hernia,
part of the stomach protrudes upward through the
opening (hiatus) at the esophagus and the diaphragm.
The stomach is normally located in the abdomen. The
esophagus connects the throat to the stomach, and the
diaphragm is a group of muscles used for breathing,
located between the abdomen and the lungs.
Who gets it?
Hiatal hernias are more likely to occur in females
than males, and are very common during middle age.
People who are obese or have had abdominal surgery are
at higher risk for hernias. The risk also increases
with age. Hiatal hernias can occur in children and
adults.
What causes it?
Hiatal hernias are caused by a weakness in the
muscle tissue at the opening in the diaphragm where the
esophagus passes through to the stomach. In some
people, this weakness is congenital, which means it is
present at birth. In others, it develops over time, as
a result of excessive weight gain, physical activity
that places pressure on the abdomen, pregnancy, heavy
lifting, straining during bowel movements because of
constipation, severe vomiting, or chronic and intense
coughing. Because the muscle is weak, the hernia occurs
during abdominal strain.
What are the symptoms?
A hiatal hernia cannot be seen on the outside of the
body, and may not cause any symptoms at all. Patients
who do experience symptoms usually feel a burning
sensation in the chest and throat a short time after
eating. This is called gastroesophageal reflux and is
caused by stomach acids being pushed up into the
esophagus. Other symptoms include heartburn, an
uncomfortably full feeling after eating, and the
frequent need to belch. A serious complication of a
hiatal hernia can occur if the part of the stomach that
is herniated becomes twisted or pinched by the
diaphragm. This is called a strangulated hiatal hernia.
If this happens, that portion of the stomach can lose
its blood supply. Symptoms include severe chest pain,
bloating, and difficulty swallowing. Very large hiatal
hernias can develop lesions that bleed and cause anemia
from the blood loss.
How is it diagnosed?
To diagnose a hiatal hernia, your doctor will rely
upon your description of symptoms and a series of
diagnostic tests. These may include endoscopy or a
barium swallow. With endoscopy, a flexible viewing tube
is inserted through the mouth and down to the stomach
so the doctor can check for the hiatal hernia between
the esophagus and the stomach. You will be given a mild
sedative during the procedure so you will feel no
discomfort. With a barium swallow, x-rays are taken
after you drink a special barium solution. The barium
helps reveal the bulge of a hiatal hernia on the x-ray.
Both tests can be done on an outpatient basis.
What is the treatment?
The treatment for hiatal hernias is focused on diet
and surgery is rarely necessary. Doctors recommend
restricting your intake of spicy and acidic foods and
beverages, caffeinated beverages, and chocolate;
elevating your head when lying down to prevent
gastroesophageal reflux; remaining in an upright
position after eating; and using antacids and
acid-reducing medications. Patients with hiatal hernias
find that symptoms are reduced if they eat frequent
small meals throughout the day. Surgery is necessary
for a strangulated hiatal hernia and very large hiatal
hernias that cause severe gastroesophageal reflux. This
procedure may be performed through laparoscopic
surgery, in which the surgeon uses a special viewing
instrument called a laparoscope, inserted through a
small incision in the chest or abdomen. The laparoscope
is like a tiny video camera that gives the surgeon a
clear view of the abdominal area. Other small incisions
are made to insert the surgical instruments used to
pull the stomach back down into the abdomen and repair
the weak muscle or make a smaller opening between the
diaphragm and the esophagus.
Self-care tips
Although there is no way to prevent hernias due to a
congenital weakness, you can help reduce your risk for
a hiatal hernia. Follow a healthy diet that is high in
fiber and drink plenty of fluids to prevent
constipation, maintain a healthy weight through diet
and exercise, and avoid cigarette smoking, which can
cause chronic coughs. If your job requires heavy
lifting, learn the proper way to lift and wear a
support garment. Certain medications can aggravate a
hiatal hernia. Your doctor can recommend which
medications to avoid if you have this condition.
This information has been designed as a comprehensive and quick reference
guide written by our health care reviewers. The health information written
by our authors is intended to be a supplement to the care provided by your
physician. It is not intended nor implied to be a substitute for
professional medical advice.
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