A hiatal hernia takes place once an organ or body tissue pushes through our diaphragm. A diaphragm happens to be a membrane that helps maintain the position of our abdomen’s organs while isolating them from our heart and lungs within the chest cavity. It is a muscular, dome-shaped layer between 2 holes, and it supports our breathing by moving up and down.
The diaphragm consists of a smooth surface without any open hole, although the main vessels and structures run through it. The food pipe (also known as the esophagus) happens to be the biggest of these structures. The throat is responsible for connecting the rear part of our mouth to the stomach while helping to push down the food for digestion.
The diaphragm typically encircles the esophagus tightly for maintaining the position of the tissues and abdominal organs. This helps to prevent stomach contents from moving back into the food pipe’s chest section.
A hiatal hernia is going to happen once a portion of our upper stomach pushes at this point via the diaphragm.
Risk factors and causes
It is not clear what causes this condition. The pressure exerted on the diaphragm might be one probable cause, and some people might be having more risks because of genetic factors.
The hiatus, which is an opening within the diaphragm, can become weakened, and this might be because of several risk factors. Other factors might consist of an upward force that occurs due to weightlifting or persistent vomiting or coughing. The pressure within our abdominal cavity is temporarily increased because of these actions.
Pregnant women can also suffer from the symptoms of a hiatal hernia. The abdominal organs are pushed upward by the developing fetus, which causes the organs to bulge via the diaphragm, where it comes in contact with the esophagus.
One more cause might be a congenital anomaly within the diaphragm, although it is rare. Symptoms of a hiatal hernia can happen in case an injury is caused to the diaphragm, which might occur because of any traffic mishap or fall.
What are the symptoms of a hiatal hernia?
No symptoms will be caused by hiatal hernia, and it is mostly found once an individual has abdominal X-rays or chest X-ray, including:
- CT scans when the patient is going to swallow barium or any other contrast substance.
- It is likewise found at the time of gastrointestinal endoscopy of the stomach, duodenum, and the esophagus.
- In case symptoms of a hiatal hernia do happen, they are because of GERD (gastroesophageal reflux disease), in which case the digestive juice consisting of acid moves into the food pipe.
Unfortunately, no similar protective lining is present in the food pipe. Instead, it depends on the LES (lower esophageal sphincter), which happens to be a group of muscles situated at the junction of the esophagus and the stomach, as well as on the diaphragm’s tissue that surrounds the food pipe.
Apart from this, the esophageal and stomach junction location is essential to the LES (esophageal sphincter) for maintaining the original position of the acid. Unlike the chest cavity, more pressure is exerted inside the abdominal cavity. However, the combo of pressure exerted inside the lower is mostly from the LES, while the diaphragm’s muscle helps to create an area of high pressure, which keeps the stomach acid within the stomach.
The esophagus and gastroesophageal junction move on top of the diaphragm in case of a sliding hiatal hernia into the chest. The part of the area with higher pressure because of the diaphragm becomes lost. The esophagus lining becomes inflamed since acid goes back into the food pipe.
The GERD symptoms consist of
- Chest pain
- Retching or vomiting
What makes the symptoms of a hiatal hernia worse?
- The hiatal hernia symptoms typically become worse following meals and might become even worse if the person is lying flat.
- In some individuals suffering from the condition, it is going to reflux into the esophagus setting off nervous reflexes, which might lead to a spasm within the lungs or cough.
- In rare cases, acid droplets might be refluxed into the rear part of the throat, which might lead to asthma, coughing spasms, or lung infections.
Individuals of all ages can suffer from hiatal hernia. However, it is quite rare.
What are the symptoms of paraesophageal hiatal hernia?
In most cases, individuals suffering from a paraesophageal sphincter do not have any reflux symptoms since the junction of the gastroesophageal esophagus is beneath the diaphragm. However, if the hernia happens to be large, there is a chance of the stomach’s volvulus where the stomach will be twisting upon itself. Luckily, paraesophageal hernias occur to be quite rare.
What are the hiatal hernia types?
There are three hiatal hernia types.
Sling hiatal hernia
This type of hiatal hernia happens to be the most common type at present. It accounts for almost 90% of all the Hiatal hernias. In this case, a part of the stomach will slide through the diaphragm upward into the chest so that the stomach’s junction and the esophagus lie within the breast.
A sliding hernia will be present at the time of inspiration. At the same time, the diaphragm descends and contracts in the direction of the abdominal cavity while the food pipe shortens at the time of swallowing, although it is not present at rest.
This type of hernia accounts for just 5% of the Hiatal hernias at present. The gap within the diaphragm using which the hernia takes place is more prominent, and a part of the stomach is going to herniate alongside the food pipe into the chest. However, the junction between the food pipe and the stomach stays beneath the diaphragm.
Paraesophageal and sliding hernia
In case the defect within the diaphragm becomes more prominent, the junction between the esophagus and the stomach can herniate into the chest using the diaphragm resulting in a hernia that happens to be sliding as well as paraesophageal.
What tests and procedures can diagnose hiatal hernias
Here are the possible tests you need to do:
EDG, CT scan, and X-rays
On most occasions, a hiatal hernia is incidentally found with EGD, gastrointestinal X-rays, and at times with CT scan because there are no symptoms of a hiatal hernia. Treatment will only be required once there are any associated symptoms of GERD. With GERD symptoms, hiatal hernia can be present since most individuals suffering from GERD have got Hiatal hernias.
Upper GI series or barium swallow
On many occasions, upper GI series or a barium swallow will be able to confirm the hiatal hernia diagnosis in which case a radiologist uses fluoroscopy for observing in real-time while the barium that has been swallowed outlines the food pipe, the small intestine, and the stomach. Apart from understanding the anatomy, the radiologist will likewise comment on the muscle movements which function to propel the food and the barium into the stomach via the esophagus.
This a procedure in which a gastroenterologist usually performs under sedation for looking into the lining of the stomach, duodenum, and the esophagus. This helps to diagnose the symptoms of a hiatal hernia quickly, and the doctor can see the GERD complications as well from the acid reflux. Doctors make use of endoscopy for diagnosing scarring along with strictures plus precancerous conditions such as Barrett’s esophagus. The physician might take small tissue samples or biopsies under a microscope for examination.
It is a fact that obesity can lead to hiatal hernia, and therefore, weight reduction might help some individuals minimize the risk of the condition. It will not be possible to prevent other risk factors and known causes of hiatal hernia.
Any person having this condition might find that they will be able to lessen the symptoms of heartburn by making changes in their diet. An individual ought to decrease the following:
- Portion size
- Overall meal size
- Intake of specific food items leading to reflux
One can also minimize the symptoms if they reduce the consumption of subsequent foods and beverages:
- Spicy or fatty foods
It is also essential to maintain the timing of the consumption of the food items since mealtimes can affect the movement of the acid onto the esophagus. Individuals suffering from heartburn must sit in an upright position while ingesting foods and take meals at least a couple of hours before going to sleep.
One can also lessen the symptoms by elevating the head portion of the mattress such that the bed is going to slope a bit in the direction of the feet. Nevertheless, it is essential to incline the entire body apart from the head.
People who are affected with hiatal hernia can get treatment in various ways.
You will come across treatments for relieving acid reflux symptoms over the counter these days. These consist of antacids that are available as chewy tablets or liquids out there and help minimize the stomach’s acidity.
You might also get help from alginate substances. These provide a barrier to the acidic contents of the stomach by making a foamy gel.
Physicians can prescribe more potent medicines like lansoprazole for patients having persistent symptoms.
On rare occasions, patients with hiatal hernia might need surgery, in which case they will be under general anesthesia. In case medication treatments and lifestyle changes are not adequate, individuals suffering from severe reflux issues might need to have an operation. Surgery is also imperative in case the hernia is so big that it disrupts the supply of blood.
The hiatal hernia operations happen to be laparoscopic. Surgeons will make small keyhole cuts instead of making a big incision for operating.
It will be possible to treat sliding hiatal hernia with the help of a standard procedure known as LNF. Lasting for about 90 minutes, this operation intends to pull back the stomach into position, and it will likewise make the diaphragm tight around the esophagus for preventing any further bulging. Recent studies found that any person can experience an improvement of 90% in their symptoms following an LNF.
In case you are suffering from gastroesophageal reflux symptoms, you can resort to the following self-care measures:
- Consume several smaller meals regularly instead of 3 larger meals. This will not exert much pressure on the stomach.
- Consume most fluids in between meals (instead of during meal times). Refrain from taking carbonated beverages.
- Avoid drinks and foods that might aggravate the reflux symptoms like spicy food items, chocolate, citrus fruits, alcoholic beverages, meals based on tomatoes, and caffeinated drinks like coffee, cola, and tea.
- Stay away from fatty food items since they can help relax the muscle in the lower esophagus and slow down the stomach’s emptying. This will provide the acid with more time to reflux into the food pipe.
- Do not perform any exercise before 2 hours of consuming food.
- Never lie down after a meal and wait for a minimum of 3 hours before going to sleep. By that time, most of the food consumed by you will move into the small intestine and not be able to go back to the esophagus.
- Do not stoop or bend over, particularly after consumption of food. Try not to lift any heavy object since it might cause strain to you.
- Do not put on any tight clothing, which will restrict your stomach and chest.
- Quit smoking since smoking will help to increase the reflux of stomach acid.
Make it a point to lose weight in case you happen to be overweight. This will help to lessen the pressure on the stomach, thus reducing symptoms. Consult with your medical practitioner regarding which weight-reduction plan will be appropriate for you.
In case you are not able to control your symptoms despite taking these measures, seek your physician’s advice for further treatment options.