What is a hiatal hernia?
A hiatal hernia is a medical condition that occurs when a portion of the stomach pushes through the esophageal hiatus, an opening in the diaphragm. The esophagus passes through the esophageal hiatus as it carries food to the stomach.
Researchers estimate that around 60% of adults will have a hiatal hernia, to some degree, by the time they reach 60 years of age. However, that percentage is considered to be conservative because many people who have hiatal hernias never experience any symptoms. They may never know that they have the condition
Signs and symptoms of a hiatal hernia
Common symptoms of hiatal hernia include:
- Acid reflux
- Acid taste in your mouth
- Regurgitation of liquid or food into your mouth
- Swallowing difficulty
- Dry Cough
- Burning in the stomach or esophagus
- Bad breath
- Stomach pain or pain in the esophagus
- Chest pain
While these are basic symptoms, they can differ depending on the location of the hernia in the upper region of the digestive system.
Though most hiatal hernias are relatively safe, there are times when complications can arise. Esophageal ulcers and strangulated hiatal hernia are life threatening issues and should be attended to immediately. If you find that you have any of these symptoms, you need to see your doctor immediately:
These symptoms could indicate a more serious condition that could be life threatening.
Types of hiatal hernia
There are two types of hiatal hernia, a sliding hiatal hernia and a paraesophageal hiatal hernia. Doctors often subdivide paraesophageal hiatal hernias to include an additional two classifications. However, the sliding hiatal hernia is the most common, making up more than 95% of all cases.
The sliding hiatal hernia occurs when a portion of the stomach works its way through the esophageal hiatus. This leaves part of the stomach sitting above the diaphragm. It is a common cause of gastroesophageal reflux disease (GERD).
If you have a paraesophageal hernia, the stomach and esophagus remain in their correct positions — but a portion, or fold, of the stomach enters the chest cavity by squeezing through the hiatus. The stomach is then positioned next to the esophagus. There are different levels of paraesophageal hernia, depending on the severity and risk the condition presents.
Causes of a hiatal hernia
There are several apparent risk factors and medical conditions that often coincide with the development of a hiatal hernia, but sometimes the cause is never known. Doctors have identified several groups that tend to be more prone to getting a hiatal hernia. These people are:
Conditions and situations that may cause hiatal hernias include:
- Heavy lifting
- Weakness of the diaphragm tissues
- Straining from a bowel movement
- Straining from exercise
Accidents that cause trauma to the area resulting in a hiatal hernia
Hiatal hernias are very common, but researchers have not been able to identify exact causes in many situations. This makes it difficult to offer any definitive preventive measures.
Diagnosing a hiatal hernia
Your doctor may suspect you have a hiatal hernia if you are having trouble with chest discomfort and heartburn, especially when you bend forward, eat a large meal, or lift something heavy, If you fall into any of the high risk categories — due to obesity, age, or smoking habits — they will also take that into consideration.
- In order to confirm a hiatal hernia diagnosis, your doctor may order these tests:
- Chest X-ray: An X-ray of your chest can show a hiatal hernia if it is big enough
- Barium swallow: You drink a barium-based liquid. On an X-ray, barium appears white. This allows the doctor to see certain things about the hernia, including its position and size.
- Esophagoscopy: A tube with a tiny camera attached to the end is used to examine the esophagus.
- Gastric emptying test: This test determines how long it takes food to leave your stomach.
- Manometry: Pressure in the esophagus is measured to find any movements in the muscles that are not normal.
Many of the risk factors for hiatal hernias are also risk factors for coronary artery disease. The symptoms of these two conditions are also very similar. Because of this, your doctor may also order an electrocardiogram (EKG) to rule out heart complications.
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Treatments for hiatal hernia
The majority of people who have hiatal hernias do not need treatment. When a person has trouble with reflux symptoms that are believed to be associated with a hiatal hernia, they can often make certain lifestyle changes and find relief.
Eating smaller meals and avoiding bedtime snacking are two major changes that tend to help with the symptoms. If the person does not get relief from making changes to their lifestyle, then the next step is prescribing an acid blocker or recommending antacids.
Surgery is rarely required. Fewer than 5% of people who have a hiatal hernia ever need surgery. However, if your reflux symptoms are persistent — or your esophagus remains inflamed — even after you have been on medication, surgery may be an option. Your doctor may also recommend surgery if you have a paraesophageal hernia that is at risk of becoming trapped.
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Best Practice & Research. Clinical Gastroenterology: "Approaches to the Diagnosis ad Grading of Hiatal Hernia."
Gastroenterology & Hepatology: "Hiatal Hernia and the Treatment of Acid-Related Disorders."
Gut Liver: "Clinical significance of hiatal hernia."
Harvard Health Publishing: "Hiatal Hernia."
University of Michigan Medicine: "Hiatal Hernias."
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