Hiatal Hernia

A hernia is a protrusion of part of an organ through the muscle wall that surrounds it. A hiatal hernia occurs when the upper part of the stomach pushes up into the chest through a small opening (called the hiatus) in the diaphragm, the muscle that separates the abdomen from the chest.

Most of the time, a hiatal hernia is small enough not to cause any Symptoms. However, if hiatal hernia is large enough, the opening in the diaphragm increases, allowing more of stomach and sometimes other organs to slide into chest. Sometimes, the hernia squeezes stomach, causing restriction and discomfort. The stomach may rotate and twist as well. This results in retention of acid, which can easily back up into esophagus, causing gastroesophageal reflux disease (GERD), heartburn, chest pain, swallowing problems, and breathing problems.

Types

  • Hernias are referred to by various names including hiatal hernia, paraesophageal hernia and the most rare, diaphragmatic hernia.
  • Hernias are also categorized by their size and configuration. The vast majority are called Type I, or sliding hiatal hernias. In this type of hernia, the stomach intermittently slides up into the chest through a small opening in the diaphragm.
  • Types II, III, and IV hernias are called paraesophageal hernias, which happen when a portion of the stomach pushes up into the chest adjacent to the esophagus. These hernias are much less common, but more concerning, because the blood supply to the stomach can be threatened and Symptoms tend to be more severe.

The cause of hernias is unknown. Men and women of all ages can develop a hernia, but possible triggers include the following:

  • Older than 50
  • Pregnancy
  • Obesity

Persistent pressure on the muscles of the hiatus caused by:

  • Coughing
  • Vomiting
  • Straining while having a bowel movement
  • Sudden physical exertion
  • Lifting heavy objects

Most of the time, a hernia does not cause Symptoms but when it does they include:

  • Heartburn
    • Belching
    • Nausea
    • Vomiting
    • Regurgitation or backflow of stomach contents into the esophagus

More severe Symptoms are usually associated with a paraesophageal hernia. Those signs and Symptoms include:

  • Intermittent difficulty swallowing, especially solid foods
  • Feeling full after eating only a small amount of food
  • Abdominal or chest pain
  • Difficulty breathing after meals or increased shortness of breath
  • Voice changes
  • Abdominal bleeding, the signs of which can be: Bright red blood in vomit
  • Dark red or black stools
  • Anemia
  • Blood test showing there is blood loss

Patients with paraesophageal hernias may have a significant portion of their stomach or other abdominal organs push up into their chest. In severe cases, the stomach or abdominal organs may rotate or twist, causing severe pain. This is a medical emergency and will likely require immediate surgery.

  • Strangulation (twisted in a way that cuts off blood supply to the stomach
  • Severe gastroesophageal reflux disease (GERD)
  • Esophagitis (inflammation of the esophagus)
  • Chronic anemia or  need for blood transfusions
  • Recurrent pneumonia or infection
  • Pain or inability to vomit

 

How is it diagnosed?

After a careful medical exam and taking medical history, following tests needed to determine the cause of Symptoms:
  • Chest X-ray, electromagnetic energy produces images of internal tissues, bones and organs.
  • Chest CT-scan, a series of detailed pictures inside of the body, taken from different angles by a computer linked to an X-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly.
  • Upper Endoscopy (EGD), an endoscope is inserted through the mouth and into the esophagus allowing the surgeon to see the lining of the esophagus and remove a tissue sample (a biopsy), which is examined in a laboratory.
  • Barium Swallow/Upper GI study involves X-ray pictures of the esophagus and stomach after swallowing a small amount of contrast material. If a patient complains of trouble swallowing, a barium swallow may be helpful in identifying areas of narrowing called strictures.

How is it treated?

  • Hernias can often be monitored regularly. However, Treatment may be necessary if the hernia is:
    • In danger of becoming strangulated (twisted in a way that cuts off blood supply to the stomach
    • Complicated by severe gastroesophageal reflux disease (GERD)
    • Complicated by esophagitis (inflammation of the esophagus)
    • Causing chronic anemia or a need for blood transfusions
    • Causing recurrent pneumonia or infection
    • Causing pain or inability to vomit
  • Medication to neutralize stomach acid, decrease stomach acid, or improve stomach motility.
  • Minimally Invasive Surgery - Laparoscopic surgery to reduce the size of the hernia or to prevent strangulation by closing the opening in the diaphragm. We perform laparoscopic operations by inserting a small video camera into the abdomen and viewing the procedure on a monitor, giving them better visualization and access. A fundoplication is performed in addition to reducing the hernia to help decrease acid and fluid from coming up from the stomach after the hernia is repaired. Fundoplication is usually performed as a laparoscopic procedure.

Consult with experienced Doctors

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