Hiatal Hernia

Defining Hiatal Hernia

A hernia occurs when an organ or tissue exits or moves abnormally from its location. The hiatus is found on the diaphragm, which separates the chest cavity and the abdomen. Hence, the name the hiatal hernia is used to describe the condition where the stomach starts protruding outside the abdominal cavity through the hiatal opening. The food pipe or esophagus travels through the hiatus and connects to the stomach. A hiatal hernia occurs when the upper part of the stomach starts jutting out of this opening.

A hiatal hernia can be broadly classified into two different categories – sliding type and para-esophageal type. The sliding type of a hiatal hernia occurs when the stomach and esophagus slide up the hiatus, intruding the chest cavity.

This is the most commonly occurring type with almost 95% cases of all the hiatal hernia falling in this category.

The para-esophageal type hernia, also known as fixed the hiatal hernia, is caused by the stomach pushing through the diaphragm wall and laying static in the chest cavity.

Though in a majority of para-esophageal hernia cases the symptoms are not that extreme, it may sometimes lead to restricted blood flow to the stomach.

Causes and risk factors

The chances of developing the hiatal hernia increase with age, mostly in the 50s.  Obesity and smoking also increase the likelihood of a hiatal hernia. It affects women more than men. The following causative factors explain the occurrence of this ailment:

• If the abdominal muscles are weak and the individual experiences increased abdominal pressure, the hiatal hernia can occur. This is the reason why obese people and pregnant women are more likely to suffer from this disease.
• The intra-abdominal pressure may also be created due to frequent vomiting and/or chronic constipation. Any prolonged difficulty in passing bowels may gradually lead to pressure build-up in the abdominal cavity and cause the oesophageal membrane to weaken.
• Old age and smoking are also responsible for making the abdominal membranes weak such that they are not able to withstand the pressure.
• Malfunctioning of the liver which leads to a collection of fluids in the stomach may also cause a hiatal hernia. The liquid increases pressure and causes the stomach to bulge out of the diaphragm.
• The damage may also be caused by sudden or repetitive lifting of heavy luggage.
• Persistent coughs, physical injury to the abdomen or being born with a larger hiatal opening may also contribute to a hiatal hernia.

How is a hiatal hernia detected?

Maximum cases of a hiatal hernia go undetected since they don’t tend to lead to the manifestation of visible symptoms. Nevertheless, mild to severe the hiatal hernia can cause the following symptoms to develop in an individual:

• The most common symptom of a hiatal hernia is GERD or gastroesophageal reflux disease (acid reflux). Under this complication, the contents of the stomach tend to return back to the esophagus causing heartburn, chest pains and even vomiting. The person can experience a mild taste of acid in the back of the mouth. This pain, in case of a hiatal hernia, increases upon lying down.
• Waterbrash is another side effect of acid reflux caused by a hiatal hernia where large amounts of saliva accumulate in the mouth.
• Due to abnormalities within the food-pipe, the individual may also experience troubling in swallowing food and feeling much bloated after meals.
• The person will belch more, may develop a sore throat and hoarse voice, and have shortness of breath.
• A hiatal hernia might also cause internal gastrointestinal bleeding which can be detected through blood in vomit and/or passing of black stool.
• If left untreated, the symptoms may acquire many severe forms and lead to anemia (iron-deficiency), complete bowel obstruction, and volvulus.

Since the symptoms of a hiatal hernia overlap those of many other ailments, this condition is also termed as the “great mimic”.

Diagnosis

A hiatal hernia can be diagnosed through the following methods:

• Blood tests to check the iron-level in the blood since anemia is frequently detected alongside a hiatal hernia.
• Esophagram or a Barium X-ray reveals the state of the upper abdomen in the individual. In this method, the person drinks a liquid containing barium prior to the X-ray. The movement of liquid through the digestive tract leaves a trace of barium which can be seen on the x-ray image. A the hiatal hernia is detected if the barium trace is intruding the diaphragm.
• Endoscopy may also be used to check for inflammation and swelling of the hiatus. Any digestive tract obstruction can be easily detected through an endoscope.
• A manometer or a thin catheter is used to detect the pressure inside the abdominal cavity. This is made to pass through the patient’s nose and check for oesophageal movements.

How is it treated?

The treatment of a hiatal hernia depends upon the severity of the symptoms and also upon the level of organ displacement. If the symptoms are limited to only GERD (acid reflux), then it can be treated with medications. If the conditions are more severe, then surgery would be required. An overall lifestyle change is also needed to completely treat a hernia.

• Medication: The medicines are used to suppress the acid-reflux tendencies. Over-the-counter medicines such as Gelusil, which are effective antacids, are prescribed by the doctor. Certain drugs, which inhibit the acid-production in the stomach such Famotidine, are also helpful. Proton-pump inhibitors such as Omeprazole, which heal the damaged oesophageal tissues, also included within the treatment protocol.
• Surgery: This surgical treatment is made necessary when the medications fail to improve the situation. The common surgical processes used are thoracotomy, laparotomy, or laparoscopic surgery.
• Long-term lifestyle changes: These aim to control the severity of acid reflux and other associated symptoms. Eating smaller meals, quitting smoking, avoiding alcohol, and reducing weight have been helpful in bringing down the effects a hiatal hernia.

How can one prevent a hiatal hernia?

A hiatal hernia cannot be avoided completely; one can stick to the following guidelines to reduce the likelihood of contracting this disease:

• Maintain a healthy weight.
• Keeping bowel movements strain-free.
• Eating a healthy balanced diet that doesn’t strain the digestive tract.
• Lifting heavy objects with your knees.
• Not indulging in smoking and excessive alcohol intake.

References