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Reliable data on the occurrence of hiatus hernia in people who do not display symptoms is not available. Prevalence data for hiatal hernias is usually derived from patients who have had an upper endoscopy for other causes, where the hernia was coincidentally found .
An article published in the South Korean journal Gut and Liver reviewed data from several studies and reported that hiatal hernias were found in 50-94% of patients who suffer from reflux esophagitis and in 72% to 96% of patients with Barrett's esophagus.
A hiatal hernia (hiatus hernia) happens when the upper part of the stomach pushes into the abdominal (chest) cavity through the esophageal hiatus (an opening for the esophagus to pass through) in the diaphragm. There are four types of hiatal hernias in type I hernias called sliding hernias, part of the stomach and the gastroesophageal junction move into the chest. In type II hernias called para-esophageal hernias, only part of the stomach moves into the chest while the gastroesophageal junction remains in its place. Type III hernias are a mixture of type I and type II hernias. In a type IV hernia the stomach and another structure such as the colon or small intestine move through the hiatus into the abdomen. The gastroesophageal junction is the where the lower part of the esophagus meets the stomach. This junction contains the lower esophageal sphincter which normally prevents the acid and digestive contents of the stomach from passing back into the esophagus.
The direct cause of hiatal hernias has yet to be determined but they usually occur as a result of a weakened diaphragm muscle or due to increased abdominal pressure. Rarely, hiatal hernias may be congenital. Some of the risk factors that increase the risk of a hiatal hernia include lifting heavy objects, old age (above 50), pregnancy, straining during the discharge of feces from the body, smoking, and being overweight or obese. A hiatal hernia occurs when the muscles around the esophageal hiatus weaken. As a result, the upper part of the stomach moves through the hiatus into the abdominal cavity (chest cavity).
Generally, people with hiatal hernias are asymptomatic (do not display any symptoms). Signs and symptoms of hiatal hernia may include heartburn , acid reflux , foul smelling breath , and pain during or difficulty swallowing .
Diagnosis of a hiatal hernia is comprised of asking about patient history possibly, laboratory tests , barium swallow , endoscopy and an esophageal manometry.
In asymptomatic people the hiatal hernia doesn’t require treatment. Symptoms that may appear are usually a result of acid reflux, a possible complication. In this case, the reflux is treated using lifestyle changes such as avoiding foods that may worsen reflux (tomatoes, high fat foods) and losing weight, or using medications like antacids. If the hernia itself is causing other symptoms such as chest discomfort then surgery to repair it may be necessary.
Possible complications of hiatal hernias include iron deficiency anemia due to ulcers and an increased risk of gastroesophageal reflux disease which may lead to esophagitis (inflammation of the esophagus), Barrett's esophagus (precancerous changes to the esophagus) and cancer of the esophagus.
Preventing a hiatal hernia is difficult. It is possible however to reduce the risk of getting it by maintaining a healthy body weight, not smoking and not lifting heavy objects. Generally, the prognosis for people with hiatal hernias is excellent seeing as most cases are asymptomatic and most of the symptoms that may appear can be managed with medication.
Reliable data on the occurrence of hiatus hernia in people who do not display symptoms is not available. Prevalence data for hiatal hernias are usually derived from patients who have had an upper endoscopy for other causes where the hernia was coincidentally found . An article published in the South Korean journal Gut and Liver reviewed data from several studies and reported that hiatal hernias were found in 50-94% of patients who suffer from reflux esophagitis and in 72% to 96% of patients with Barrett's esophagus.
A hiatal hernia (hiatus hernia) occurs when the upper part of the stomach protrudes into the chest cavity through an opening (hiatus) in the diaphragm.
There are several types of hiatal hernias
Type I hernia - a sliding hernia, the most common type, the gastroesophageal junction and a part of the stomach move into the chest through the esophageal hiatus (an opening in the diaphragm for the esophagus to pass through) . The gastroesophageal junction is the where the lower part of the esophagus meets the stomach. This junction contains the lower esophageal sphincter which normally prevents the acid and digestive contents of the stomach from passing back into the esophagus. Sliding hernias are also called concentric or axial hiatal hernia .
Type II hernia -para-esophageal hernia, also called rolling-type hiatal hernia3. In this type of hernia a part of the stomach (the fundus) moves into the chest. The gastroesophageal junction, however, remains in its place below the diaphragm.
Type III hernia - a mixture of both types of hiatal hernia.
Type IV hernia - In addition to the stomach, another structure such as the colon or small intestine move through the hiatus into the abdomen .
It’s not clear what the direct cause of hiatal hernia is but it usually occurs due to a weakened diaphragm muscle or due to increased abdominal pressure . Rarely, hiatal hernias may be congenital.
Risk factors that could contribute to the formation of a hiatal hernia include :
Normally, the esophagus passes through a hiatus (opening) in the diaphragm called the esophageal hiatus to reach the stomach. A hiatal hernia happens when the muscles around the hiatus become weak, causing the upper part of the stomach to protrude through this hiatus into the abdominal cavity (chest) .
Most people with hiatal hernias do not display any symptoms. Signs and symptoms of hiatal hernia may including :
Diagnosis is done by asking about patient history, imaging tests and possibly laboratory tests.
The doctor begins by asking about patient history. The doctor should inquire if the patient experiences chest discomfort or heartburn, particularly when bending forward, eating a heavy meal or lifting heavy objects.
Laboratory tests are only used if the patient displays symptoms of gastroesophageal reflux disease or after an image of the chest indicated the presence of a paraesophageal hernia. They are also used to check for anemia which may help indicate the presence of bleeding as a result of the hernia .
The patient drinks a special liquid that enables x-rays to determine the presence of esophageal problems (eg. swallowing disorders) or stomach problems (ulcers and tumors). This test enables the doctor to determine the size and position of the hiatal hernia, if the contents of the stomach are leaking back into the esophagus and if the stomach is twisted due to the hernia . The test also enables the doctor to determine the type of hernia.
A tube with a camera is inserted through the esophagus into the stomach. The test is primarily used to diagnose complications of the hernia such as ulcers.
An esophageal manometry measures the strength and coordination of the esophageal muscles during swallowing.
If the hernia is large, it may show up on the x-ray .
To rule out coronary artery disease since the age group at highest risk for hernias is also at highest risk for coronary artery disease.
This test indicates the amount of acid in the esophagus. It helps identify which of the symptoms that may appear are a result of this acid.
This test is used for people who experience nausea and vomiting. The test measures the time it takes for food to leave the stomach and results may help the doctor determine the cause of nausea or vomiting.
If the hiatal hernia is asymptomatic (doesn’t show symptoms) it doesn’t require treatment. This is true for most cases of hiatal hernia. If symptoms start to appear it is usually due to the acid reflux that occurs as complication of the hernia. If the hernia itself is causing other symptoms such as chest discomfort then surgery to repair it may be necessary. Treatment to relieve the reflux includes lifestyle changes, medication, and surgery .
Lifestyle changes are usually used to manage the symptoms of gastroesophageal reflux disease such as heartburn. The changes include:
Medications are used to treat acid reflux.
Antacids neutralize stomach acid.
H2 blockers decrease acid production. They act slower than antacids, but provide longer relief. Their effect may last up to 12 hours.
PPIs lower the quantity of acid produced by the stomach. They are also able to heal the lining of the esophagus that might have been damaged due to the acid.
In a few cases surgery might be required. Surgery is necessary in emergency situations, for example if a paraesophageal hernia becomes trapped in the chest, and if the heartburn and reflux are not improving with medication. The surgery aims to amend the gastroesophageal reflux in order to prevent long term complications such as esophagitis (inflammation of the esophagus) .
Surgery entails moving the hiatal hernia back into the abdomen and narrowing the esophageal hiatus or reforming the weakened lower esophageal sphincter (valve at the junction of the stomach and esophagus) .
Some possible complications of hiatal hernias include
Preventing a hiatal hernia is difficult. It is possible however to reduce the risk of getting a hiatal hernia by not smoking and maintaining a healthy body weight. Avoiding activities that increase the strain and pressure on the abdomen such as lifting heavy objects may also decrease the risk of hiatal hernias. For people who consistently need to strain while discharging feces from the body, they could try increasing their fiber consumption or asking their doctor for medication to soften their stool.
The general prognosis for people with hiatal hernias is excellent as only a few cases develop symptoms. In addition, most of the symptoms can be managed with medication .
Reliable data on the occurrence of hiatus hernia in people who do not display symptoms is not available. Prevalence data for hiatal hernias is usually derived from patients who have had an upper endoscopy for other causes, where the hernia was coincidentally found .
An article published in the South Korean journal Gut and Liver reviewed data from several studies and reported that hiatal hernias were found in 50-94% of patients who suffer from reflux esophagitis and in 72% to 96% of patients with Barrett's esophagus.
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