Overview
A hiatal hernia occurs when the upper part of your stomach bulges through the large muscle separating your abdomen and chest (diaphragm), causing a small opening for the food tube (esophagus) to pass through. It usually doesn't cause problems, but larger hernias may lead to heartburn, regurgitation, acid reflux, difficulty swallowing, chest or abdominal pain, feeling full soon after eating, shortness of breath, and vomiting blood or passing black stools. A doctor should be consulted if there are persistent signs or symptoms that cause concern.
Understanding the disease
Symptoms
The symptoms of a hiatal hernia may include heartburn, regurgitation of food or liquids into the mouth, backflow of stomach acid into the esophagus (acid reflux), difficulty swallowing, chest or abdominal pain, feeling full soon after eating, shortness of breath, and vomiting of blood or passing of black stools, which may indicate gastrointestinal bleeding. However, most small hiatal hernias cause no signs or symptoms. If you have any persistent signs or symptoms that worry you, it is recommended to see a doctor.
Risk Factors
Hiatal hernias are most common in people who are:
- Age 50 or older
- Obese about other risk factors .
Development
A hiatal hernia occurs when the upper part of your stomach bulges through the large muscle separating your abdomen and chest (diaphragm). It happens when weakened muscle tissue allows your stomach to bulge up through your diaphragm. A hiatal hernia can develop due to age-related changes in your diaphragm, injury to the area, being born with an unusually large hiatus, or persistent and intense pressure on the surrounding muscles. In many cases, the abdominal wall weakness that leads to hiatal hernias is present at birth, but the hernia doesn't cause symptoms unless it becomes larger. Hiatal hernias are most common in people who are age 50 or older, obese, or experiencing persistent and intense pressure on the surrounding muscles.
Assessment and Diagnosis
Triage
You should see a doctor if you experience persistent signs or symptoms that worry you, such as heartburn, regurgitation of food or liquids, backflow of stomach acid into the esophagus (acid reflux), difficulty swallowing, chest or abdominal pain, feeling full soon after eating, shortness of breath, or vomiting blood or passing black stools, which may indicate gastrointestinal bleeding. A doctor will be able to confirm the presence of a hiatal hernia and recommend appropriate treatment options.
Diagnosis
Hiatal hernia can be diagnosed through the following tests or procedures:
- X-ray of your upper digestive system: This involves drinking a chalky liquid that coats and fills the inside lining of your digestive tract, allowing your doctor to see a silhouette of your esophagus, stomach, and upper intestine.
- Upper endoscopy: Your doctor inserts a thin, flexible tube equipped with a light and camera (endoscope) down your throat to examine the inside of your esophagus and stomach and check for inflammation.
- Esophageal manometry: This test measures the rhythmic muscle contractions in your esophagus when you swallow. Esophageal manometry also measures the coordination and force exerted by the muscles of your esophagus. These tests can help determine the presence and severity of a hiatal hernia.
Management and Treatment
Complications
Potential complications of a hiatal hernia include:
- Gastroesophageal reflux disease (GERD): A large hiatal hernia can cause stomach acid to back up into the esophagus, leading to GERD symptoms like heartburn, regurgitation, and difficulty swallowing.
- Bleeding: In severe cases, a hiatal hernia can cause gastrointestinal bleeding, which can manifest as vomiting blood or passing black stools.
- Incarceration or strangulation: Although rare, a large hiatal hernia can cause the stomach to become trapped in the chest, leading to incarceration or strangulation. Incarceration can cause severe pain, nausea, vomiting, and the inability to have a bowel movement or pass gas. Strangulation is a life-threatening complication that requires immediate surgery. It's important to see a doctor if you experience persistent signs or symptoms related to a hiatal hernia, as these complications can be serious and require medical intervention.
Treatment
Treatments for hiatal hernia typically involve managing symptoms through self-care measures, medications, or surgery, depending on the severity of the hernia.
- Self-care measures: Lifestyle changes can help alleviate symptoms of hiatal hernia. These may include:
- Avoiding large or heavy meals.
- Eating slowly and steadily.
- Not lying down after eating.
- Losing weight if you're overweight.
- Avoiding foods that trigger heartburn or acid reflux.
- Medications: Over-the-counter or prescription medications can help manage symptoms associated with hiatal hernia. These may include:
- Antacids to neutralize stomach acid.
- Acid-reducing medications to decrease acid production in the stomach.
- Proton pump inhibitors to block stomach acid production.
- Pro-motility medications to help move food through the stomach and intestines.
- Surgery: In some cases, surgery may be necessary for a large hiatal hernia that causes significant symptoms, or if there are complications such as severe acid reflux, bleeding, or obstruction. Surgical options include:
- Nissen fundoplication: This procedure involves wrapping the upper part of the stomach around the lower part of the esophagus to strengthen the muscle and prevent acid reflux.
- Hernioplasty: This surgery repairs the hernia by patching or reinforcing the weakened area of the diaphragm. It's important to consult with a healthcare professional for an accurate diagnosis and appropriate treatment plan tailored to your specific condition.