Comprehensive Guide to Hiatal Hernia: Causes, Symptoms, and Treatment

What is Hiatal Hernia

Dealing with a hiatal hernia can be a journey on it’s own, marked by discomfort and uncertainty on it’s treatment.

Understanding the nuances of hiatal hernia symptoms, causes, and treatment options, including the potential for hiatal hernia surgery, is crucial for those navigating this health issue.

Our comprehensive guide will help you understand hiatal hernia symptoms, explore the underlying causes, and discuss the procedures involved in hiatal hernia repair.

What is a Hiatal Hernia?

A hiatal hernia is characterized by a part of your stomach being displaced or having moved into your chest cavity through an opening called the esophageal hiatus. The esophageal hiatus is located in the diaphragm which is a muscle that parts the chest from the abdomen and serves as the normal passage of the food pipe (esophagus)  into the abdomen from the chest cavity.

Hiatal Hernia causes

Hiatal hernia causes can vary from person to person. Still, they all involve a weakening or widening of the hiatus, the opening in the diaphragm that enables the oesophagus to pass through. 

A hiatal hernia happens when your stomach pushes through your diaphragm due to weakening muscle structure. Sometimes, it’s unclear why this occurs. However, a hiatal hernia may result from:

  • Changes in your diaphragm that come with age.
  • Damage to the region following trauma or specific surgical procedures.
  • Having a very large hiatus by birth.
  • Strong pressure applied consistently to the surrounding muscles can occur when you exercise, lift heavy objects, cough, vomit, or strain during a bowel movement.

Hiatal Hernia Symptoms to watch out for

A hiatal hernia may be completely asymptomatic and diagnosed only when tests are done for other conditions. The commonest test which usually detects a hiatal hernia is an upper GI endoscopy. However it is also uncommonly found when other tests such as a barium swallow or a CT scan is done for unrelated symptoms. 

However when they are symptomatic they can cause any of the Typical signs include:

  • Heartburn 
  • Acid regurgitation
  • Epigastric pain or chest pain
  • Difficulty swallowing
  • Difficulty breathing if it is a large hernia.

Awareness of these potential hiatal hernia symptoms can help individuals seek proper medical attention and treatment.

How is Hiatal Hernia Diagnosed?

Diagnosing a hiatal hernia can be done through various methods, typically endoscopic or X ray imaging tests. If you’re experiencing symptoms such as heartburn, chest pain, or difficulty swallowing, it’s important to seek medical attention for an accurate diagnosis.

The commonest diagnostic procedure is an endoscopy procedure where a slender tube with a camera fixed at the end is inserted into your throat to examine the area directly.

One common diagnostic test used is an upper gastrointestinal (GI) series. This involves drinking a contrast solution while X-rays are taken to help visualize the structure of your oesophagus and stomach. 

An Oesophageal  manometry test to assess muscle function in your esophageal sphincter also aids in the diagnosis of Hiatal hernias.

Sometimes the diagnosis of a hiatal hernia and the relevance of the hernia  to your symptoms may be confusing. Not all hiatal hernias need to be treated or operated upon.  So, if you suspect you might have one, don’t hesitate to consult with a qualified doctor who specializes in esophageal  disorders.

What are the risks? Treatment of a smaller symptomatic hiatal hernia with reflux

Hiatal hernia treatment varies by severity and symptoms, focusing on symptom management and complication prevention.

Lifestyle Changes: For mild cases, adjustments like weight management, avoiding reflux triggers, eating smaller meals, and not lying down post-meal can help.

Medications: Antacids neutralize stomach acid, while proton pump inhibitors (PPIs) and H2 blockers reduce acid production, alleviating heartburn and reflux damage.

Endoscopic Procedures: Suitable for those avoiding surgery, these minimally invasive repairs use a camera-equipped tube.

Surgical Intervention: Required for severe cases or when other treatments fail, surgery repairs the hiatus and strengthens the oesophagal sphincter, with methods including Nissen fundoplication or laparoscopic techniques.

Treatment of a symptomatic large hiatal hernia

The symptoms of a large hernia may vary from reflux symptoms, chest pain, difficulty swallowing, shortness of breath etc.

The only treatment for large hernias is surgery and this decision is to be made after consultation with an oesophageal surgeon who can advice you on the benefits and risks if needed. The surgery is more complex and needs to be done by specialist upper GI surgeons only.

Types of Hernia Surgery 

While medication and lifestyle modifications are frequently effective treatments for smaller hiatal hernias, some patients may require surgery to correct their hernias.

Surgery is usually done laparoscopically using a keyhole technique with small cuts on your abdomen and involves reducing the stomach from the chest cavity into the abdomen in the first instance, narrowing the opening through which the hernia happenned and then fixing it within the abdominal cavity or combining it with an antireflux procedure if needed.. Based on the stage of your hiatal hernia, a surgeon will make a surgical recommendation. 

Hiatus hernia repair. The enlarged hiatus—the diaphragmatic orifice through which the oesophagus passes on its route to the stomach—is tightened and reduced in size during this surgical procedure using sutures or a  prosthetic mesh. 

Fundoplication. To secure the stomach below the diaphragmatic hiatus, this operation entails wrapping the fundus, the upper section of the stomach, over the lower segment of the oesophagus using stitches. Food and stomach acid cannot pass up your oesophagus after surgery which cures the reflux.

Collis-Nissen gastroplasty. When a patient has an oesophagal shortening-related hiatal hernia, surgery is performed to lengthen the oesophagus. During this treatment, the surgeon will extend your oesophagus using tissue from the top portion of your stomach.

The hospital stay may last 1-2 days after surgery prior to discharge.

Post-surgery, patients undergo a recovery phase with phased introduction to normal diet  with follow-up appointments essential for monitoring healing.

Consult Dr Balaji today for hiatal hernia treatment

If you suspect that you may have a hiatal hernia or are experiencing symptoms associated with it, it is important to seek medical attention. Consulting with an experienced and skilled healthcare professional like Dr. Balaji can help ensure an accurate diagnosis and appropriate treatment plan.

Dr. Balaji specializes in hiatal hernia repair, utilizing non-surgical and surgical approaches depending on the individual case. With his expertise and compassionate care, you can feel confident that your concerns will be addressed effectively.

Early detection is a key to successfully managing hiatal hernias. Don’t wait 

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