Hiatal Hernia
In this article
What is hiatus?
There is a large muscle separating your abdomen and chest called diaphragm. Your diaphragm has a small opening (hiatus) through which your food tube (oesophagus) passes before connecting to your stomach.
What is a hiatal hernia?
A hiatal hernia occurs when the upper part of your stomach bulges through the (often abnormally dilated) opening of the diaphragm.
A small hiatal hernia usually doesn't cause problems. You may never know you have one unless your doctor discovers it when checking for another condition.
But a large hiatal hernia can allow food and acid to back up into your oesophagus, leading to heartburn or more serious complications such as Barrett’s oesophagus. A very large hiatal hernia might require surgery.
What are the symptoms?
Most small hiatal hernias cause no signs or symptoms. But larger hiatal hernias can cause:
- Heartburn
- Regurgitation of food or liquids into the mouth
- Backflow of stomach acid into the oesophagus (acid reflux)
- Difficulty swallowing
- Chest or abdominal pain
- Shortness of breath
- Vomiting of blood or passing of black stools, which may indicate gastrointestinal bleeding
Why does it occur?
A hiatal hernia occurs when weakened muscle tissue allows your stomach to bulge up through your diaphragm. It's not always clear why this happens. But a hiatal hernia might be caused by:
- Age-related changes in your diaphragm
- Injury to the area, for example, after trauma or certain types of surgery
- Being born with an unusually large hiatus or weak diaphragmatic muscle, both which is common in some families
- Weakened diaphragmatic muscle due to persistent and intense pressure on the surrounding muscles, such as while coughing, vomiting, straining during a bowel movement, exercising or lifting heavy objects
- Weakened diaphragmatic muscle due to changes observed in obesity or smoking
How is it diagnosed?
A hiatal hernia is often discovered during a test or procedure to determine the cause of heartburn or chest or upper abdominal pain. These tests or procedures include:
Barium Swallow
X-ray of your upper digestive system. X-rays are taken after you drink a chalky liquid that coats and fills the inside lining of your digestive tract. The coating allows your doctor to see a silhouette of your oesophagus, stomach and upper intestine.
Upper Gastro-Intestinal Endoscopy
Your doctor inserts a thin, flexible tube equipped with a light and camera (endoscope) down your throat, to examine the inside of your oesophagus and stomach and check for inflammation.
Oesophageal manometry
This test measures the rhythmic muscle contractions in your oesophagus when you swallow. Oesophageal manometry also measures the coordination and force exerted by the muscles of your oesophagus.
How is it treated?
Most people with a hiatal hernia don't experience any signs or symptoms and won't need treatment. If you experience signs and symptoms, such as recurrent heartburn and acid reflux, you may need medication or surgery.
Medications
Antacids that neutralize stomach acid. They may provide quick relief but the effects are temporary. Overuse of some antacids can cause side effects, such as diarrhoea or sometimes kidney problems.
- Medications to reduce acid production. These medications — known as H-2-receptor blockers — include cimetidine and ranitidine.
- Medications that block acid production and heal the oesophagus. These medications — known as proton pump inhibitors — are stronger acid blockers than H-2-receptor blockers and allow time for damaged oesophageal tissue to heal.
Surgery
Sometimes a hiatal hernia requires surgery. Surgery is generally used for people who aren't helped by medications to relieve heartburn and acid reflux, or have complications such as severe inflammation, barrett’s or narrowing of the oesophagus.
Surgery to repair a hiatal hernia may involve pulling your stomach down into your abdomen and making the opening in your diaphragm smaller, reconstructing an oesophageal sphincter or removing the hernia sac. Commonest surgery is a Laparoscopic Nissen’s Fundoplication.