A hiatal hernia occurs when a portion of the stomach protrudes into the chest through an opening in the diaphragm, a muscular barrier that separates the abdominal cavity from the chest cavity. Hiatal hernias become more likely as we age. Symptoms of this condition can include heartburn, chest pain, indigestion, and difficulty swallowing, making it one of the most common types of hernias. The opening in the diaphragm, known as the esophageal hiatus, is the cause of hiatal hernia.
A hiatal hernia is characterized by the upper part of the stomach pushing up into the chest through an opening in the diaphragm. This condition can strain an existing weak spot in the diaphragm, called the esophageal hiatus, which may expand over time, especially during periods of stress.
There are two main types of hiatal hernias: sliding hiatal hernias and paraesophageal hiatal hernias. Sliding hiatal hernia, or type 1, is the most common type, where the part of the esophagus connecting to the stomach periodically slides upward through the expanding opening. Paraesophageal hiatal hernias, on the other hand, involve the upper part of the stomach pushing up next to the esophagus, creating a bulge.
Hiatal hernia can lead to symptoms like heartburn, chest pain, burping, sore throat, and indigestion. Some individuals with hiatal hernia may not experience any symptoms, but when they do occur, they might include:
- Burning sensation in the chest after eating
- Indigestion and bloating
- Belching and vomiting
- Stomach acid flowing back into the esophagus
- Difficulty swallowing or a feeling of a lump in the throat when swallowing
- Sore throat and hoarseness due to irritation from stomach acid
- Bad breath
- Digestive problems
- Shortness of breath due to the hernia pressing on the lungs
Hiatal hernia can be caused by factors such as aging, obesity, genetic predisposition, smoking, an unhealthy diet, and muscle weakening. Pregnancy, birth defects, and heavy lifting are also potential causes. Chronic coughing or sneezing, constipation, severe obesity, frequent vomiting, intense exercise or heavy lifting, and pregnancy and childbirth are among the common triggers of hiatal hernia.
Chronic acid reflux is one of the primary issues associated with hiatal hernia. Severe chronic acid reflux can result in damage to the esophagus when medications alone are insufficient. Complications of chronic acid reflux may include:
- Reflux esophagitis: Acid in the esophagus can cause inflammation, leading to chronic pain, swallowing difficulties, ulcers, and bleeding.
- Esophageal stenosis: Chronic inflammation can harm esophageal tissues and weaken the swallowing muscles.
- Gastritis: Acid trapped in the herniated part of the stomach can lead to inflammation, stomach ulcers, and bleeding.
- Ischemia: When the hernia compresses surrounding tissues, it can restrict blood flow, causing inflammation and pain in the affected organ.
A doctor can diagnose hiatal hernia through a physical examination and by examining images of the esophagus and stomach. In some cases, symptoms of acid reflux can indicate hiatal hernia. Diagnostic tests for hiatal hernia may include:
- Chest X-ray
- Esophagram: This test captures real-time videos of the esophagus while swallowing.
- Endoscopy: A small camera at the end of a long tube is used to examine the esophagus and stomach.
- Esophageal manometry: This test measures muscle pressure in the esophagus using a catheter.
The treatment of hiatal hernia is determined by the specialist doctor, who considers the structure of the hernia, the extent of reflux, and the patient's symptoms. If the hiatal hernia is not causing discomfort, treatment may not be necessary, but regular follow-ups are recommended because it can expand over time. Treatments may include:
- Medications to reduce stomach acid, which can alleviate symptoms but don't stop acid reflux entirely.
- Surgery may be an option for some individuals. It may be recommended if medications do not effectively control symptoms, leading to complications that impact the quality of life.
- What can help with hiatal hernia at home?
Lifestyle changes can help alleviate symptoms of hiatal hernia. These include consuming smaller meals, avoiding fatty foods that trigger stomach acid, eating dinner earlier, sleeping with the head elevated and on the left side to prevent reflux, and quitting smoking.
- Where is the pain from hiatal hernia typically felt?
Hiatal hernia pain often occurs behind the breastbone and can result in a burning sensation in the stomach, acid reflux, and throat discomfort.
- What is a giant hiatal hernia?
A giant hiatal hernia is one in which at least one-third of the stomach enters the chest cavity rather than remaining in its proper location.
- Is a giant hiatal hernia fatal?
Giant hiatal hernia itself is not fatal, but it can lead to serious problems. Ulcers within the herniated part of the stomach can cause significant bleeding or perforation. One study found that patients with untreated giant hiatal hernias had a fourfold increased risk of death compared to those who underwent surgical correction.
- What is a rupture of a giant hiatal hernia?
A rupture of a giant hiatal hernia is popularly referred to as the rupture of an ulcer within the hernia. This is a serious condition, as ulcers can perforate, allowing stomach contents to spill into the chest cavity, requiring urgent medical intervention.