Hiatal Hernia: Understanding the Condition and Its Treatment Options

May 6, 2023

What is a Hiatal Hernia and How Does it Develop?

A hiatal hernia is a condition in which a portion of the stomach bulges through an opening in the diaphragm, called the hiatus, into the chest cavity. The diaphragm is a muscle that separates the chest and abdominal cavities, and the hiatus is an opening in the diaphragm that allows the esophagus to pass through and connect to the stomach.

There are two main types of hiatal hernias:

  • Sliding hiatal hernia: This is the most common type of hiatal hernia. It occurs when a portion of the stomach and the upper part of the stomach’s covering, called the gastric fundus, protrude through the hiatus and into the chest cavity.
  • Paraesophageal hiatal hernia: This type of hiatal hernia occurs when a portion of the stomach protrudes through the hiatus and into the chest cavity, but the gastroesophageal junction (where the esophagus connects to the stomach) remains in its normal position.

Hiatal hernias can occur in people of all ages, but they are more common in people over 50 years old.

Causes of Hiatal Hernia

The exact cause of hiatal hernias is not known, but several factors may contribute to its development:

  • Aging: As we age, the muscles in the diaphragm and the surrounding tissues may weaken, which can make it easier for a hernia to develop.
  • Obesity: Being overweight or obese can put extra pressure on the diaphragm, making it more likely for a hernia to develop.
  • Smoking: Smoking can weaken the muscles in the diaphragm and surrounding tissues, which can make it easier for a hernia to develop.
  • Pregnancy: Pregnancy can put extra pressure on the diaphragm, making it more likely for a hernia to develop.
  • Frequent heavy lifting: Lifting heavy objects can put extra pressure on the diaphragm, making it more likely for a hernia to develop.
  • Certain medical conditions: Some medical conditions such as chronic cough, asthma, or emphysema can put extra pressure on the diaphragm, making it more likely for a hernia to develop.

Risk Factors

  • Age: Hiatal hernias are more common in people over 50 years old.
  • Obesity: People who are overweight or obese have a higher risk of developing a hiatal hernia.
  • Smoking: Smokers have a higher risk of developing a hiatal hernia.
  • Pregnancy: Pregnant women have a higher risk of developing a hiatal hernia.
  • Frequent heavy lifting: People who frequently lift heavy objects have a higher risk of developing a hiatal hernia.
  • Certain medical conditions: People with certain medical conditions such as chronic cough, asthma, or emphysema have a higher risk of developing a hiatal hernia.

It is important to note that many people with hiatal hernias do not experience any symptoms. However, if symptoms do occur, they can include chest pain, heartburn, and difficulty swallowing. If you suspect you may have a hiatal hernia or are experiencing symptoms, it is important to speak with your healthcare provider for proper diagnosis and treatment.

Symptoms and Diagnosis of Hiatal Hernia

Hiatal hernias often do not cause any symptoms and are often discovered during a routine physical examination or imaging test for another condition. However, when symptoms do occur, they can include:

  • Heartburn: This is the most common symptom of hiatal hernia. It occurs when stomach acid flows back into the esophagus. This can cause a burning sensation in the chest or throat, also called acid reflux.
  • Chest pain: Some people with hiatal hernias experience chest pain, which can be mistaken for angina or even a heart attack.
  • Difficulty swallowing: Hiatal hernias can cause food to become stuck in the esophagus, making it difficult to swallow.
  • Belching or burping: Some people with hiatal hernias experience belching or burping more frequently.
  • Bloating or feeling full: Hiatal hernias can cause food to become trapped in the stomach, causing bloating or feeling full.
  • Vomiting: Hiatal hernias can cause stomach contents to flow back into the esophagus and eventually the mouth, leading to vomiting.

It is important to note that these symptoms can also be caused by other conditions, so it is important to speak with a healthcare provider for proper diagnosis.

Diagnosis

To diagnose a hiatal hernia, your healthcare provider will likely perform a physical examination and ask about your symptoms. They may also recommend the following tests:

  • Upper endoscopy: This test uses a thin, flexible tube with a light and camera on the end to examine the inside of the esophagus and stomach.
  • Barium swallow: This test involves drinking a chalky liquid that contains barium and then taking X-rays to see the inside of the esophagus and stomach.
  • Esophageal manometry: This test measures the muscle contractions in the esophagus and can help determine if there is a problem with the muscle coordination.
  • pH monitoring: This test measures the acidity level in the esophagus to see if acid reflux is occurring.

If a hiatal hernia is found, the healthcare provider will likely recommend treatment options that will be discussed in the next article. It’s important to note that not all hiatal hernias require treatment and in some cases, it’s manage conservatively with lifestyle changes and medication.

Complications and Risks of Hiatal Hernia

Hiatal hernias are often benign and do not cause any symptoms or complications. However, in some cases, hiatal hernias can lead to more serious problems.

Complications

  • Acid reflux: One of the most common complications of hiatal hernias is acid reflux. When a portion of the stomach bulges into the chest cavity, it can cause stomach acid to flow back into the esophagus, leading to heartburn and other symptoms of acid reflux.
  • Esophagitis: Acid reflux can also cause inflammation in the esophagus, called esophagitis. This can cause pain, difficulty swallowing, and bleeding.
  • Barrett’s esophagus: Long-term acid reflux can cause abnormal cell changes in the lining of the esophagus, called Barrett’s esophagus. This can increase the risk of esophageal cancer.
  • Strictures: Acid reflux can cause the esophagus to narrow, creating a stricture. This can make it difficult to swallow food.
  • Gastroesophageal junction obstruction: In rare cases, a hiatal hernia can cause the stomach to become trapped in the chest cavity, leading to a blockage of the gastroesophageal junction, which can cause difficulty swallowing, vomiting and sometimes chest pain.

Risks

  • Age: Hiatal hernias are more common in people over 50 years old.
  • Obesity: People who are overweight or obese have a higher risk of developing a hiatal hernia.
  • Smoking: Smokers have a higher risk of developing a hiatal hernia.
  • Pregnancy: Pregnant women have a higher risk of developing a hiatal hernia.
  • Frequent heavy lifting: People who frequently lift heavy objects have a higher risk of developing a hiatal hernia.
  • Certain medical conditions: People with certain medical conditions such as chronic cough, asthma, or emphysema have a higher risk of developing a hiatal hernia.

It’s important to note that not everyone with a hiatal hernia will experience complications and that in most cases, hiatal hernias can be managed with lifestyle changes and medication. However, if complications arise or symptoms persist, surgical intervention may be necessary. Your healthcare provider will discuss the best course of treatment for you based on your individual case.

Conservative and Medical Treatment for Hiatal Hernia

Many people with hiatal hernias do not experience any symptoms and do not require treatment. However, for those who do experience symptoms, there are several conservative and medical treatment options available.

Conservative Treatment

  • Lifestyle changes: Making changes to your lifestyle can help reduce symptoms and prevent complications. Some lifestyle changes that may be recommended include:
    • Losing weight if you are overweight or obese.
    • Avoiding foods and drinks that can trigger acid reflux, such as spicy foods, caffeine, and alcohol.
    • Avoiding eating large meals or eating late at night.
    • Not lying down or going to bed within 2-3 hours after eating.
    • Quitting smoking.
  • Medications: Medications can help reduce symptoms of acid reflux and prevent complications. Some common medications that may be prescribed include:
    • Antacids: Antacids neutralize stomach acid and can provide quick relief from heartburn.
    • H-2 receptor blockers: These medications reduce the amount of acid produced by the stomach and can provide longer-term relief from heartburn.
    • Proton pump inhibitors: These medications reduce the amount of acid produced by the stomach and are the most effective medications for treating acid reflux.

Medical Treatment

  • Endoscopic Procedures: In some cases, an endoscopic procedure may be recommended to help improve symptoms and prevent complications. Some common endoscopic procedures include:
    • Endoscopic fundoplication: This procedure involves using an endoscope to place a small ring of plastic or magnetic beads around the esophagus and the stomach. This helps prevent acid reflux.
    • Endoscopic suturing: This procedure involves using an endoscope to place sutures in the stomach to help prevent acid reflux.
  • Surgical Treatment: In some cases, surgical treatment may be necessary to repair a hiatal hernia or to address complications. Some common surgical procedures include:
    • Nissen fundoplication: This procedure involves wrapping the upper part of the stomach around the lower part of the esophagus to help prevent acid reflux.
    • Hiatal hernia repair: This procedure involves surgically repairing the hernia and moving the stomach back into its proper position in the abdominal cavity.

It’s important to note that the best course of treatment for a hiatal hernia will depend on the individual case and will be determined by a healthcare provider. In some cases, a combination of treatments may be necessary to manage symptoms and prevent complications.

Surgical Management of Hiatal Hernia

In some cases, surgical treatment may be necessary to repair a hiatal hernia or to address complications. The type of surgical procedure will depend on the size and type of hernia, as well as the individual’s symptoms and overall health.

Types of Surgical Procedures

  • Nissen Fundoplication: This is the most common surgical procedure for hiatal hernias. It is performed under general anesthesia and involves wrapping the upper part of the stomach (the fundus) around the lower part of the esophagus to create a new valve that helps prevent acid reflux. The procedure can be performed through an open incision in the abdomen or laparoscopically, through small incisions in the abdomen.
  • Toupet Fundoplication: This is a variation of the Nissen Fundoplication. It is also performed under general anesthesia and involves wrapping a smaller portion of the upper stomach around the esophagus, which creates a new valve that helps prevent acid reflux. This procedure is typically recommended for people who experience symptoms of acid reflux but do not have a large hiatal hernia.
  • Hiatal Hernia Repair: This procedure is performed under general anesthesia and involves surgically repairing the hernia and moving the stomach back into its proper position in the abdominal cavity. The procedure can be performed through an open incision or laparoscopically.

Recovery

Recovery time for hiatal hernia surgery varies depending on the type of procedure and the individual’s overall health. Most people can return to work and normal activities within 2-4 weeks, but it may take several weeks or months to fully recover.

Risks

As with any surgical procedure, there are risks associated with hiatal hernia surgery. These include bleeding, infection, and injury to surrounding organs. Additionally, some people may experience difficulty swallowing or bloating after surgery. Your healthcare provider will discuss the risks and benefits of surgery with you and help you decide if it is the best course of treatment for you.

It’s important to note that not all hiatal hernias require surgery and that in most cases, hiatal hernias can be managed with lifestyle changes and medication. However, if complications arise or symptoms persist, surgical intervention may be necessary. Your healthcare provider will discuss the best course of treatment for you based on your individual case.

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