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Hiatus Hernia

Description

A hiatus hernia is an abnormal exit of upper stomach into the chest cavity through a weakness or tear in the diaphragm. Hiatus is a normal opening in the diaphragm for the passage of esophagus into the abdominal cavity. If the esophageal hiatus is abnormally large, upper portion of stomach may slip into the chest cavity. There are two types of hiatal hernia:

  1. Sliding hiatal hernia: It is most common type of hiatal hernia in which the stomach and esophagus pass into the hiatus but comes back to its normal position once the pressure in abdomen is relieved.
  2. Fixed or paraesophageal hernia: In this type, the bulging or protrusion remains in the chest cavity at all times. This type is rare but may cause serious damage.
Causes

Although the exact causes of hiatal hernia are not discovered but studies have found the following factors contributing to it:

  1. Increased abdominal pressure: Increase pressure in the abdominal cavity may be due to weight lifting, pregnancy, obesity, hard sneezing, or constipation. Following conditions may cause the stomach to slip into the thoracic cavity.
  2. Age changes in diaphragm: Diaphragm may get weak with age, increasing the risk of hiatal hernia.
  3. Trauma: Injury to the diaphragm can also cause hiatal hernia.
  4. Congenital: Some children are born with abnormally large hiatal opening, leading to hiatal hernia.
Risk factors

Following factors increase the risk of developing hiatal hernia:

  • Gender: Females are more prone to developing hiatus hernia.
  • Age: People older than 50 years of age have increased chances of getting hiatus hernia.
  • Obesity: Increased weight increases the abdominal pressure, leading to increased risk of hiatus hernia.
  • Smoking
Symptoms
  • Acidity and getting a bitter taste in mouth after a burp.
  • Heaviness and pain in abdomen.
  • After a meal feeling Bloated (frequent burps and farts)
  • Difficulty in swallowing.
  • Bad breath.
  • Breathing problem due to pressure on chest.
  • In severe cases, vomiting and sharp pain in abdomen, an indication of blockage of hernia.
Diagnosis

A long-standing case of acidity and gastric pain is further confirmed by:

  • Endoscopy (a visual of the stomach and specifically hernia)
  • Barium meal swallow (a special kind of X-ray to see the stomach)
  • pH tests to measure acidity of stomach.
  • Pressure tests (manometry) to check the muscle strength and activity of food pipe (esophagus).
Management
  • Non-surgical management:

The goal of non-surgical management is to alleviate the symptoms, especially of acid reflux. It includes:

 Lifestyle modifications:

  • Avoid foods that trigger the symptoms
  • Avoid eating large meals
  • Avoid eating fatty meals
  • Avoid lying down after eating
  • Exercise regularly
  • Quit smoking.

 

 

 

Medicines:

  1. Antacids
  2. Proton pump inhibitors
  3. Histamine H2 agonists.


  • Surgical management:

You need surgical treatment if you have a fixed hiatal hernia because of increased risk of strangulation of the stomach. No surgical management is required for asymptomatic sliding hiatus hernia.

When to consult a doctor?

Complications like bloody vomiting may be due to cancer or internal infection in the digestive tract , inability to pass stool may suggest blockage of tract, chest tightness can be from angina, heart attack or other chest disease.

In a situation where complications arise, you must consult a general physician or specialist to give you the proper care and treatment.

Available Medicine for Hiatus Hernia

Gaviscon

Rs.199

Reckitt

Gaviscon Advance

Rs.224.1

Reckitt

Lagita Advance

Rs.166.05

Sami

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