Hiatal Hernia: Causes, Symptoms, and Treatment Options 2024

What is it?

A hiatal hernia occurs when the upper part of your stomach pushes through the diaphragm, the muscle separating your chest from your abdomen. This can cause discomfort and digestive problems, as stomach acid can leak back up into the esophagus, leading to heartburn and other symptoms.

Causes:

The exact cause of many hiatal hernias is unknown, but several factors may contribute, including:

Age-related changes: As we age, the diaphragm muscle naturally weakens, making it more likely for a hernia to develop.

Injury: Damage to the diaphragm from an accident or other trauma can create a weak spot where a hernia can form.

Congenital: Some people are born with an unusually large opening in the diaphragm, which increases the risk of a hiatal hernia.

Lifestyle factors: Activities that put pressure on the diaphragm, such as coughing, vomiting, heavy lifting, and straining during bowel movements, can contribute to a hernia.

Smoking: Smoking weakens the muscles in the body, including the diaphragm.

Types:

There are two main types of hiatal hernias:

Sliding hiatal hernia: This is the most common type, accounting for about 95% of cases. In this type, the part of the stomach that connects to the esophagus (the gastroesophageal junction) slides up into the chest cavity through the weakened area in the diaphragm.

Paraesophageal hiatal hernia: This type is less common but can be more serious. In a paraesophageal hernia, the stomach pushes up through the diaphragm beside the esophagus, rather than sliding through the opening with it. This type of hernia increases the risk of complications like strangulation, where the blood supply to the stomach is cut off.

Symptoms:

Symptoms of a hiatal hernia can vary depending on the size and location of the hernia, as well as individual factors. Some common symptoms include:

Heartburn: A burning sensation in the chest and throat, caused by stomach acid backing up into the esophagus.
Regurgitation: Food or liquid coming back up into the mouth.
Trouble swallowing: Difficulty getting food or liquids down.
Chest pain: Pain or discomfort in the chest or upper abdomen.
Feeling full quickly: Feeling satiated after eating small amounts.
Belching: Frequent burping.
Hiccups: Persistent hiccups that are difficult to control.

Not everyone with a hiatal hernia will experience symptoms. In fact, some people may not even know they have one. However, if you experience any of these symptoms, it is important to see a doctor for diagnosis and treatment.

Diagnosis:

Doctors can diagnose a hiatal hernia using several tests, including:

Barium swallow: This test involves drinking a chalky liquid that coats the inside of your digestive system, making it visible on an X-ray.

Endoscopy: This procedure involves inserting a thin tube with a camera down your throat to look directly at your esophagus and stomach.

Esophageal manometry: This test measures the pressure and muscle contractions in your esophagus.

Treatment:

Treatment for a hiatal hernia will depend on the severity of the symptoms and the size and location of the hernia. In some cases, no treatment may be necessary if the symptoms are mild. However, if the symptoms are bothersome or the hernia is large or causing complications, treatment may be recommended.

Lifestyle changes:

Lifestyle changes can often help to relieve symptoms of a hiatal hernia and may even prevent the hernia from getting worse. These changes include:

Dietary modifications: Avoiding trigger foods like spicy and fatty foods, reducing caffeine and alcohol intake, and eating smaller, more frequent meals.

Maintaining a healthy weight: Excess weight can put additional pressure on the diaphragm and worsen symptoms.

Elevating the head of the bed: This can help to prevent stomach acid from backing up into the esophagus at night.

Quitting smoking: Smoking weakens the diaphragm muscle and can irritate the esophagus.

Medication:

Several medications can help to relieve symptoms of a hiatal hernia, including:

Antacids: These medications neutralize stomach acid and can provide quick relief from heartburn and indigestion.

H2 blockers: These medications reduce the amount of acid produced by the stomach.

Proton pump inhibitors (PPIs): These are the strongest type of medication for acid reflux and can be very effective in controlling symptoms.

Surgery:

In some cases, surgery may be necessary to repair a hiatal hernia. This is typically only recommended for people with severe symptoms that do not respond adequately to lifestyle changes and medication. There are three main types of surgery for hiatal hernia:

Nissen fundoplication: This is the most common type of surgery for hiatal hernia. In this procedure, the surgeon wraps the top of the stomach around the lower esophagus to strengthen the valve between the two organs and prevent stomach acid from backing up. The surgery can be performed laparoscopically, through several small incisions in the abdomen, or through an open incision in the abdomen.

Open surgery: In some cases, an open surgical approach may be necessary for larger or more complex hernias. This type of surgery involves making a larger incision in the abdomen to access the hernia and perform the repair.

Endoluminal fundoplication (ELF): This is a newer, less invasive procedure for hiatal hernia. ELF is performed through the mouth using a thin tube with a camera and tiny instruments. The surgeon creates a partial fold at the top of the stomach to tighten the valve and prevent reflux.

Recovery:

The recovery time after hiatal hernia surgery will vary depending on the type of surgery performed. Laparoscopic surgery typically requires a shorter hospital stay and faster recovery time than open surgery. In general, you can expect to spend a few days in the hospital after surgery, followed by several weeks of recovery at home.

During your recovery, it is important to:

Follow your doctor's instructions: This includes taking your medications as prescribed, eating a bland diet, and avoiding strenuous activity.

Get plenty of rest: Allow your body time to heal.

Manage your pain: Your doctor can prescribe medication to help manage pain after surgery.

Follow up with your doctor: Schedule regular follow-up appointments to monitor your progress and address any concerns.

Prognosis:

The prognosis for people with hiatal hernia is generally good. With proper treatment, most people can achieve significant relief from their symptoms and improve their quality of life. However, it is important to note that hiatal hernias can recur after surgery. In some cases, additional treatment may be necessary.

Here are some additional things to keep in mind about hiatal hernias:

Hiatal hernias are more common in older adults and people who are overweight or obese.

Men are more likely to develop a hiatal hernia than women.

Smoking can increase your risk of developing a hiatal hernia.

There are several things you can do to prevent a hiatal hernia, such as maintaining a healthy weight, avoiding trigger foods, and quitting smoking.

If you have any concerns about a hiatal hernia, be sure to talk to your doctor. They can help you determine if you have a hernia and discuss the best course of treatment for you.