Hiatal Hernia
A hiatal hernia occurs when part of the stomach pushes up through the diaphragm into the chest cavity through the hiatus, an opening in the diaphragm where the esophagus passes before connecting to the stomach.
🔍 Types of Hiatal Hernia
- Sliding Hiatal Hernia (most common)
The stomach and the section of the esophagus that joins the stomach slide up into the chest through the hiatus. - Paraesophageal Hiatal Hernia
Part of the stomach pushes through the hiatus next to the esophagus and stays there, which can be more serious because it may lead to stomach strangulation.
⚠️ Causes
- Weakness of the diaphragm muscles (age-related or congenital)
- Increased pressure in the abdomen due to:
- Heavy lifting
- Obesity
- Persistent coughing
- Straining during bowel movements
- Pregnancy
🩺 Symptoms
- Often no symptoms, especially with small hernias
- Heartburn or gastroesophageal reflux disease (GERD)
- Regurgitation of food or acid
- Difficulty swallowing
- Chest or abdominal pain
- Feeling full quickly
- Shortness of breath (rare, with large hernias)
🧪 Diagnosis
- Barium swallow X-ray: Visualizes the stomach and esophagus during swallowing
- Upper endoscopy: Directly views the esophagus and stomach lining
- Esophageal manometry: Measures esophageal muscle function
- pH monitoring: Measures acid reflux into the esophagus
🛠️ Treatment
Lifestyle and Dietary Changes
- Eat smaller, more frequent meals
- Avoid lying down immediately after eating
- Elevate the head of the bed
- Avoid trigger foods (spicy, fatty, caffeine, alcohol)
- Lose weight if overweight
- Quit smoking
Medications
- Antacids to neutralize stomach acid
- H2 blockers or proton pump inhibitors (PPIs) to reduce acid production
- Medications to improve esophageal motility (less common)
Surgery
- Considered if symptoms are severe or complications occur (e.g., paraesophageal hernia, strangulation)
- Procedures include Nissen fundoplication, where the stomach is wrapped around the lower esophagus to strengthen the valve and prevent reflux