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A hiatus hernia or hiatal hernia is the protrusion (or herniation) of the upper part of the stomach into the thorax through a tear or weakness in the diaphragm.
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A hiatus hernia or hiatal hernia is the protrusion (or herniation) of the upper part of the stomach into the thorax through a tear or weakness in the diaphragm.
Symptoms
The symptoms include acid reflux, and pain, similar to heartburn, in the chest and upper stomach.
In most patients, hiatus hernias cause no symptoms. Sometimes patients experience heartburn and regurgitation, when stomach acid refluxes back into the esophagus.
Risk factors
The following are risk factors for having a hiatus hernia.
- Increased pressure within the abdomen caused by:
- Heavy lifting or frequent bending over
- Frequent or hard coughing
- Hard sneezing
- Pregnancy and delivery
- Violent vomiting
- Straining with constipation
- Obesity (extra weight pushes down on the abdomen increasing the pressure)
- Use of the sitting position for defecation (See epidemiology below)
- Heredity
- Smoking
- Drug use, such as cocaine.Fact: date=September 2008
- Stress
Diagnosis
The diagnosis of a hiatus hernia is typically made through an upper GI series or endoscopy.
Types
There are two major kinds of hiatus hernia:
- The most common (95%) is the sliding hiatus hernia, where the gastroesophageal junction moves above the diaphragm together with some of the stomach.
- The second kind is rolling (or paraesophageal) hiatus hernia, when a part of the stomach herniates through the esophageal hiatus beside, and without movement of, the gastroesophageal junction. It is about 100 times less common than the first kind.
A third kind is also sometimes described, and is a combination of the first and second kinds.
Treatment
In most cases, sufferers experience no discomfort and no treatment is required. However, when the hiatal hernia is large, or is of the paraesophageal type, it is likely to cause esophageal stricture and discomfort. Symptomatic patients should elevate the head of their beds and avoid lying down directly after meals until treatment is rendered. If the condition has been brought on by stress, stress reduction techniques may be prescribed, or if overweight, weight loss may be indicated. Medications that lower the lower esophageal sphincter (or LES) pressure should be avoided. Antisecretory drugs like proton pump inhibitors and H2 receptor blockers can be used to reduce acid secretion.
Where hernia symptoms are severe and chronic acid reflux is involved, surgery is sometimes recommended, as chronic reflux can severely injure the esophagus and even lead to esophageal cancer.
