Steps to be Taken for the Treatment of Hiatal Hernia

What is this Condition?

Hiatal hernia is a defect in the diaphragm that permits a portion of the stomach to pass through the diaphragm’s opening into the chest. The three types of hiatal hernia are:

 Sliding hernia - both the stomach and its connection with the esophagus slip up into the chest

Paraesophageal or “rolling” hernia - a part of the big curve of the stomach rolls through the defect in the diaphragm

Mixed hernia - includes features of both of the above.

Sliding hernias are by far the most common type. The risk of developing a hiatal hernia of any type increases with age and women have a higher risk than men.

What causes it?

Hiatal hernia is usually caused by weakened esophageal muscles due to old age or cancer, injury, certain surgical procedures or, possibly, an inherited flaw in the diaphragm. The weakened muscles allow parts of the esophagus and stomach to rise when abdominal pressure is increased. Normal pressure increases occur during bending, straining, coughing, extreme physical exertion, and when you wear tight clothing. Conditions that cause increased pressure include fluid accumulation, pregnancy, and obesity.

What are its Symptoms?

A sliding hernia may not produce any symptoms and, consequently, doesn’t require treatment. When symptoms occur, they typically reflect acid backup and include:

€¢ heartburn from 1 to 4 hours after eating that is aggravated by reclining, belching, and abdominal pressure, and may be accompanied by regurgitation or vomiting

High-chest pain due to backup of stomach acid, stomach distention, and spasm that is aggravated by reclining, belching, and abdominal pressure (more common after meals or at bedtime).

Symptoms that may reflect possible complications include:

€¢ difficulty swallowing due to acid backup into the esophagus, especially after consuming very hot or cold foods, alcoholic beverages, or a large meal

€¢ bleeding (mild or massive) caused by damage to the esophagus or stomach

€¢ severe pain and shock resulting from a trapped hernia (a large part of the stomach is caught above the diaphragm), which may perforate the stomach and requires immediate surgery.

Paraesophageal hernia rarely causes a backflow of stomach acid and therefore usually does not produce symptoms. Often, it is discovered during a barium swallow X-ray ordered for some other reason. Symptoms, when present, are subtle displacement or stretching of the stomach that may give the person a feeling of stomach or chest fullness that mimics angina. Although it has few symptoms, this type of hernia requires surgical treatment because it has a high risk of strangulation.

How is it Diagnosed?

The doctor will use a scope to inspect the esophagus and its muscles for abnormalities and may take a specimen to rule out cancer or other growths. Lab studies and procedures provide more information. For example, chest X-ray can reveal a large hernia, and a barium study may show the hernia as a pouch at the lower end of the esophagus. Other lab tests can confirm stomach acid reflux, bleeding, anemia, or blood in stools.

How is it treated?

Initial treatment focuses on relieving symptoms and preventing complications. The doctor will recommend changes in diet, prescribe drugs to strengthen the lower esophageal sphincter, and explain how positioning can ease discomfort. Also the person will be provided with a list of things to avoid, such as abdominal pressure (coughing, straining, bending), constrictive clothing, and smoking (stimulates gastric acid production). Other suggested treatments include using antiemetics, antacids, cough suppressants, and stool softeners, and losing any extra weight.

If these therapies fail or complications develop, surgery may be required. Most surgeons create an artificial closing mechanism at the end of the esophagus to create a barrier between the stomach and the chest.