Hiatal Hernia (cont.)
Are there different types of hiatal hernias?
Hiatal hernias are categorized as being either sliding or para-esophageal.
Sliding hiatal hernias
Sliding hiatal hernias, the most common type of hernia, are those in which the junction of the esophagus and stomach, referred to as the gastro-esophageal junction, and part of the stomach protrude into the chest. The junction may reside
permanently in the chest, but often it juts into the chest only
during a
swallow. This occurs because with each swallow the muscle
of the esophagus contracts causing the esophagus to shorten
and to pull up the stomach. When the swallow is finished,
the herniated part of the stomach falls back into the
abdomen. Para-esophageal hernias are hernias in which the
gastro-esophageal junction stays where it belongs (attached
at the level of the diaphragm), but part of the stomach
passes or bulges into the chest beside the esophagus. The para-
esophageal hernias themselves remain in the chest at all times and
are not affected by swallows.
Para-esophageal hiatal hernias
A para-esophageal hiatal hernia that is large,
particularly if it compresses the adjacent esophagus, may
impede the passage of food into the stomach and cause food
to stick in the esophagus after it is swallowed. Ulcers
also may form in the herniated stomach due to the trauma
caused by food that is stuck or acid from the stomach.
Fortunately, large para-esophageal hernias are uncommon.
What are the symptoms of hiatal hernia?
The vast majority of hiatal hernias are of the sliding
type, and most of them are not associated with symptoms. The larger
the hernia, the more likely it is to cause symptoms.
When sliding hiatal hernias produce symptoms, they almost always are those of
gastroesophageal
reflux disease (GERD) or
its complications. This occurs because the
formation of the hernia often interferes with the barrier (lower
esophageal sphincter) which prevents acid from refluxing from the stomach
into the esophagus. Additionally, it is known
that patients with GERD are much more likely to have a hiatal hernia than
individuals not afflicted by GERD. Thus, it is clear that hiatal hernias
contribute to GERD. However, it is not clear if hiatal hernias alone can
result in GERD. Since GERD may occur in the absence of a hiatal hernia,
factors other than the presence of a hernia can cause GERD.
Symptoms of uncomplicated GERD include:
- heartburn
- regurgitation
- nausea
Next: How does a hiatal hernia cause GERD? »
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