Hiatal Hernia

What is a Hiatal Hernia?

The stomach is normally completely below the diaphragm, the muscular sheet that separates the lungs and chest from the abdomen.

A hiatal hernia occurs when part of the stomach slides through the diaphragm and protrudes into the chest cavity. Hiatal hernias are fairly common and can affect people of all ages.

There are two types of hiatal hernias:

  • Sliding hiatal hernia: Occurs when the top portion of stomach slides up and down through the diaphragm with increased pressure on the abdominal cavity
  • Fixed Hiatal hernia: Occurs when the top portion of stomach moves up into the chest cavity and does not slide down into normal position

Most small hiatal hernias don’t cause any symptoms. Larger hiatal hernias can cause symptoms such as:

  • Heartburn
  • Belching
  • Difficulty swallowing
  • Chest or abdominal pain
  • Feeling especially full after meals
  • Vomiting blood or passing black stools, which may indicate gastrointestinal bleeding

Your diaphragm is the large dome-shaped muscle that separates your chest from your abdomen. Your esophagus passes through the diaphragm into the stomach through an opening called the hiatus.

When the muscle around this opening becomes weak, the upper part of your stomach can bulge through it. It’s not always clear why this happens, but pressure on your stomach and age may be a factor.

Some risk factors include:

  • Injury
  • Having an unusually large hiatus
  • Persistent and intense pressure on the surrounding muscles, caused by:
    • Coughing
    • Vomiting
    • Straining during a bowel movement
    • Lifting heavy objects

Hiatal hernias are often discovered during tests for the cause of heartburn or abdominal pain.

Some tests include:

  • An esophagram (barium swallow): A procedure that allows your doctor to see a silhouette of your upper GI tract on an X-ray
  • Endoscopy: Your doctor passes a flexible, lighted tube down your esophagus to examine your upper GI tract
  • Manometry: Your doctor passes a pressure-sensitive catheter through your nose, down your esophagus and into your stomach to measure pressure and movement inside the esophagus

If your hiatal hernia causes heartburn and acid reflux, your doctor may recommend medications, such as:

  • Antacids
  • Medications to reduce acid production
  • Medications that block acid production and heal the esophagus
  • Over-the-counter proton pump inhibitors, such as:
    • lansoprazole (Prevacid 24HR)
    • Omeprazole (Prilosec OTC)

A small number of cases may require surgery to repair the hiatal hernia. This is generally reserved as a last resort for patients who aren’t helped by medications.

Most hiatal hernia surgeries involve pulling your stomach down into your abdomen and making the opening in your diaphragm smaller, reconstructing a weak esophageal sphincter, or removing the hernia sac.

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