What Is Hiatal Hernia? Symptoms, Causes, Diagnosis, Treatment, and Prevention

Treating a hiatal hernia can involve lifestyle changes, medication, or surgery.

Your doctor will consider a number of factors when deciding on the best course of treatment, including your general health, how large your hernia is, and the severity of your symptoms.

Recommended lifestyle changes are generally aimed at reducing symptoms of GERD and may include losing weight, avoiding acidic, fried, or fatty foods, and quitting smoking.

Your doctor may also recommend the following medications to treat GERD:

Antacids These drugs neutralize stomach acid; over-the-counter antacids include brands like Mylanta, Rolaids, and Tums.

h3-Receptor Blockers These drugs reduce acid production and include Pepcid (famotidine), Tagamet (cimedtidine), Axid (nizatidine), and Zantac (ranitidine).

Emergency surgery is needed for a hiatal hernia if your stomach is being squeezed so tightly that its blood supply is cut off.

Surgery may also be needed if you have severe GERD that isn’t responding well to lifestyle measures and medication.

To surgically repair a hiatal hernia, your doctor will pull the entire stomach back down into your abdomen and make the opening in your diaphragm smaller.

If needed, your surgeon may also repair your esophageal sphincter — the muscle that normally prevents your stomach contents from flowing back into your esophagus.

This surgery is usually done laparoscopically — involving several small incisions and using a flexible tube containing a light and camera to view the inside of your abdomen and chest.

Less often and only when necessary, your doctor may opt for an “open” procedure, which involves larger incisions, a longer recovery period, and a greater risk of infection, pain, and scarring.

Prevention of a Hiatal Hernia

It is difficult to prevent a hiatal hernia, but there are steps you can take to reduce your risk. These include maintaining a healthy weight and not smoking.

If you have a hiatal hernia that leads to GERD, the following lifestyle changes can help prevent episodes of GERD:

• Losing weight
• Reducing meal and portion size
• Avoiding acidic foods, like tomatoes and citrus fruit
• Avoiding caffeine and alcohol
• Avoiding peppermint
• Limiting carbonated beverages
• Limiting fried and fatty foods
• Eating at least three to four hours before lying down
• Keeping your head and torso elevated at least 6 inches when you rest or sleep
• Avoiding tight clothing around your abdomen and waist
• Quitting smoking

Hiatal Hernia

Overview

The esophagus sphincter muscle normally closes tightly. With a hiatal hernia, the sphincter’s new position may keep it from completely closing. The back flow of digestive juices may damage the esophagus.

What is a hiatal hernia?

A hiatal hernia occurs when the upper part of the stomach pushes through an opening in the diaphragm and into the chest cavity. The diaphragm is the thin muscle wall that separates the chest cavity from the abdomen. The opening in the diaphragm is where the esophagus and stomach join.

Who is at risk for developing a hiatal hernia?

A hiatal hernia can develop in people of all ages and both sexes, although it frequently occurs in people age 50 and older. Hiatal hernia occurs more often in overweight people and smokers.

Symptoms and Causes

What causes a hiatal hernia?

The most common cause of a hiatal hernia is an increase in pressure in the abdominal cavity. Your abdominal cavity is the space in the middle of your body that holds several organs, including the:

• Lower part of the esophagus and stomach.
• Small intestine, colon and rectum.
• Liver.
• Gallbladder, pancreas and spleen.
• Kidneys.
• Bladder.

This pressure can build up from things like:

• Coughing.
• Vomiting.
• Straining during a bowel movement.
• Heavy lifting.
• Physical strain.

There are also other reasons a hiatal hernia could develop. You may experience a hiatal hernia during pregnancy, if you are obese, or if there’s extra fluid in your abdomen.

Increased pressure in the abdomen (arrows) causes part of the stomach to push through the diaphragm and into the chest cavity.

What are the symptoms of a hiatal hernia?

Many people with a hiatal hernia never have symptoms. Some people with hiatal hernia have some of the same symptoms as gastroesophageal reflex disease (GERD). GERD occurs when digestive juices move from the stomach back into the esophagus. Symptoms of GERD include:

• Heartburn.
• Bitter or sour taste in the back of the throat.
• Bloating and belching.
• Discomfort or pain in the stomach or esophagus.

Although there appears to be a link between hiatal hernia and GERD, one condition does not seem to cause the other. Many people have a hiatal hernia without having GERD, and others have GERD without having a hiatal hernia.

Another symptom of a hiatal hernia is chest pain. Since chest pain can also be a symptom of a heart attack, it’s important to contact your healthcare provider or go to the emergency room if you experience any chest pain.

Diagnosis and Tests

How is a hiatal hernia diagnosed?

Several tests can be done to help diagnose a hiatal hernia. These include a barium swallow test, an endoscopy procedure, esophageal manometric studies, a pH test and gastric emptying studies.

• A barium swallow involves drinking a special liquid, then taking X-rays to help see problems in the esophagus (such as swallowing disorders) and the stomach (such as ulcers and tumors). It also shows how big the hiatal hernia is and if there is twisting of the stomach as a result of the hernia.
• An endoscopy is a procedure in which the inside of the upper digestive system is viewed with an endoscope (a long, thin, flexible instrument about 1/2 inch in diameter).
• An esophageal manometry measures the strength and muscle coordination of your esophagus when you swallow.
• A pH test measures the acid levels in the esophagus and helps determine which symptoms are related to acid in the esophagus.
• Gastric emptying studies examine how fast food leaves the stomach. Results from this test are especially important in patients who have nausea and vomiting. There could be other causes of the nausea and vomiting besides a hiatal hernia.

Management and Treatment

How is a hiatal hernia treated?

Most hiatal hernias do not cause problems and rarely need treatment. However, since some patients with a hiatal hernia have symptoms of GERD, treatment starts with methods used to manage GERD. These include making such lifestyle changes as:

• Losing weight if you’re overweight.
• Decreasing the portion sizes of meals.
• Avoiding certain acidic foods—such as tomato sauce and citrus fruits or juices—that can irritate the esophageal lining.
• Limiting fried and fatty foods, foods or drinks containing caffeine (including chocolate), peppermint, carbonated beverages, alcoholic beverages, ketchup and mustard, and vinegar.
• Eating meals at least three to four hours before lying down, and avoiding bedtime snacks.
• Keeping your head six inches higher than the rest of your body when lying on your back. Raising the level of your head helps gravity keep your stomach’s contents in the stomach. Raising the head of your bed by angling your mattress works best—piling your pillows doesn’t work as well because it makes you crunch your middle instead of simply angling your body upwards.
• Quitting smoking.
• Not wearing a tight belt or tight clothing that can increase the pressure on the abdomen — such as control top hosiery and body shapers.
• Taking medications after eating to reduce acid in the stomach. These over-the-counter medications include antacids, Gaviscon®, or H-blockers (such as Pepcid AC® or Zantac®).

Sometimes, a medication called a proton-pump inhibitor might be used to treat hiatal hernia. This medication is another way to decrease the amount of stomach acid you have, which can help prevent reflux. When you take this medication, your body doesn’t make as much stomach acid as normal. This is similar to H-blocker medications.

Can over-the-counter medications help relieve my hiatal hernia symptoms?

In many cases, over-the-counter medications can help you with some symptoms of hiatal hernia. Antacids are the most common medication you might use for relief. However, if you take over-the-counter medications for longer than two weeks without any improvement, see your healthcare provider. Prescription medications are typically the next step. These can include:

• Pantoprazole (Protonix®).
• Rabeprazole (Aciphex®).
• Esomeprazole (Nexium®).
• Omeprazole (Prilosec®).
• Lansoprazole (Prevacid®).

When is surgery for a hiatal hernia needed?

If the portion of the stomach entering the esophagus is being squeezed so tightly that the blood supply is being cut off, you’ll need to have surgery. Surgery may also be needed in people with a hiatal hernia who have severe, long-lasting (chronic) esophageal reflux whose symptoms are not relieved by medical treatments. The goal of this surgery is to correct gastroesophageal reflux by creating an improved valve mechanism at the bottom of the esophagus. Think of this valve as a swinging door. It opens to let food pass down into the stomach and then closes to keep stomach contents from going back up the esophagus. When this valve doesn’t work correctly, your stomach contents can go the wrong way and damage your esophagus. If left untreated, chronic gastroesophageal reflux can cause complications such as esophagitis (inflammation), esophageal ulcers, bleeding or scarring of the esophagus.

How is surgery for a hiatal hernia performed?

Surgery for repairing a hiatal hernia involves:

• Pulling the hiatal hernia back into the abdomen.
• Improving the valve at the bottom of the esophagus.
• Closing the hole in the diaphragm muscle.

During surgery, your surgeon will wrap the upper part of the stomach (called the fundus) around the lower portion of the esophagus. This creates a permanently tight sphincter (the valve) so that stomach contents will not move back (reflux) into the esophagus.

Called a fundoplication, there are two versions of this surgery. An open fundoplication surgery involves a larger incision. This type of procedure may need to be done in some very severe cases and it allows for greater visibility during surgery. However, open surgeries require a longer recovery time in the hospital. In many cases, the surgeon will decide to use a laparoscopic approach instead.

A laparoscopic surgery is done through several small incisions instead of one big cut. This is considered a minimally invasive option. The specific laparoscopic procedure used to repair a hiatal hernia is called the Nissen fundoplication. This procedure creates a permanent solution to your hiatal hernia symptoms. During the procedure, your surgeon will make five or six tiny incisions in the abdomen. The laparoscope (a tool that allows the surgical team to see your internal organs on a screen in the operating room) and other surgical instruments are inserted through the small incisions. The fundus is wrapped around the esophagus and the sphincter is tightened during surgery. The advantages of laparoscopic surgery compared to an open surgery include:

• Smaller incisions.
• Less risk of infection.
• Less pain and scarring.
• A shorter recovery.

Outlook / Prognosis

How effective is surgery for a hiatal hernia?

A laparoscopic repair of hiatal hernia and reflux, called Nissen Fundoplication, is very effective in most patients. This surgery requires general anesthesia and a short stay in the hospital. If you need to have an open surgical procedure, the recovery time will be longer and you may need to stay in the hospital for several days. After surgery, most patients no longer require long-term treatment with prescription or over-the-counter antacid medications.

Hiatal Hernia

Overview

The esophagus sphincter muscle normally closes tightly. With a hiatal hernia, the sphincter’s new position may keep it from completely closing. The back flow of digestive juices may damage the esophagus.

What is a hiatal hernia?

A hiatal hernia occurs when the upper part of the stomach pushes through an opening in the diaphragm and into the chest cavity. The diaphragm is the thin muscle wall that separates the chest cavity from the abdomen. The opening in the diaphragm is where the esophagus and stomach join.

Who is at risk for developing a hiatal hernia?

A hiatal hernia can develop in people of all ages and both sexes, although it frequently occurs in people age 50 and older. Hiatal hernia occurs more often in overweight people and smokers.

Symptoms and Causes

What causes a hiatal hernia?

The most common cause of a hiatal hernia is an increase in pressure in the abdominal cavity. Your abdominal cavity is the space in the middle of your body that holds several organs, including the:

• Lower part of the esophagus and stomach.
• Small intestine, colon and rectum.
• Liver.
• Gallbladder, pancreas and spleen.
• Kidneys.
• Bladder.

This pressure can build up from things like:

• Coughing.
• Vomiting.
• Straining during a bowel movement.
• Heavy lifting.
• Physical strain.

There are also other reasons a hiatal hernia could develop. You may experience a hiatal hernia during pregnancy, if you are obese, or if there’s extra fluid in your abdomen.

Increased pressure in the abdomen (arrows) causes part of the stomach to push through the diaphragm and into the chest cavity.

What are the symptoms of a hiatal hernia?

Many people with a hiatal hernia never have symptoms. Some people with hiatal hernia have some of the same symptoms as gastroesophageal reflex disease (GERD). GERD occurs when digestive juices move from the stomach back into the esophagus. Symptoms of GERD include:

• Heartburn.
• Bitter or sour taste in the back of the throat.
• Bloating and belching.
• Discomfort or pain in the stomach or esophagus.

Although there appears to be a link between hiatal hernia and GERD, one condition does not seem to cause the other. Many people have a hiatal hernia without having GERD, and others have GERD without having a hiatal hernia.

Another symptom of a hiatal hernia is chest pain. Since chest pain can also be a symptom of a heart attack, it’s important to contact your healthcare provider or go to the emergency room if you experience any chest pain.

Diagnosis and Tests

How is a hiatal hernia diagnosed?

Several tests can be done to help diagnose a hiatal hernia. These include a barium swallow test, an endoscopy procedure, esophageal manometric studies, a pH test and gastric emptying studies.

• A barium swallow involves drinking a special liquid, then taking X-rays to help see problems in the esophagus (such as swallowing disorders) and the stomach (such as ulcers and tumors). It also shows how big the hiatal hernia is and if there is twisting of the stomach as a result of the hernia.
• An endoscopy is a procedure in which the inside of the upper digestive system is viewed with an endoscope (a long, thin, flexible instrument about 1/2 inch in diameter).
• An esophageal manometry measures the strength and muscle coordination of your esophagus when you swallow.
• A pH test measures the acid levels in the esophagus and helps determine which symptoms are related to acid in the esophagus.
• Gastric emptying studies examine how fast food leaves the stomach. Results from this test are especially important in patients who have nausea and vomiting. There could be other causes of the nausea and vomiting besides a hiatal hernia.

Management and Treatment

How is a hiatal hernia treated?

Most hiatal hernias do not cause problems and rarely need treatment. However, since some patients with a hiatal hernia have symptoms of GERD, treatment starts with methods used to manage GERD. These include making such lifestyle changes as:

• Losing weight if you’re overweight.
• Decreasing the portion sizes of meals.
• Avoiding certain acidic foods—such as tomato sauce and citrus fruits or juices—that can irritate the esophageal lining.
• Limiting fried and fatty foods, foods or drinks containing caffeine (including chocolate), peppermint, carbonated beverages, alcoholic beverages, ketchup and mustard, and vinegar.
• Eating meals at least three to four hours before lying down, and avoiding bedtime snacks.
• Keeping your head six inches higher than the rest of your body when lying on your back. Raising the level of your head helps gravity keep your stomach’s contents in the stomach. Raising the head of your bed by angling your mattress works best—piling your pillows doesn’t work as well because it makes you crunch your middle instead of simply angling your body upwards.
• Quitting smoking.
• Not wearing a tight belt or tight clothing that can increase the pressure on the abdomen — such as control top hosiery and body shapers.
• Taking medications after eating to reduce acid in the stomach. These over-the-counter medications include antacids, Gaviscon®, or H-blockers (such as Pepcid AC® or Zantac®).

Sometimes, a medication called a proton-pump inhibitor might be used to treat hiatal hernia. This medication is another way to decrease the amount of stomach acid you have, which can help prevent reflux. When you take this medication, your body doesn’t make as much stomach acid as normal. This is similar to H-blocker medications.

Can over-the-counter medications help relieve my hiatal hernia symptoms?

In many cases, over-the-counter medications can help you with some symptoms of hiatal hernia. Antacids are the most common medication you might use for relief. However, if you take over-the-counter medications for longer than two weeks without any improvement, see your healthcare provider. Prescription medications are typically the next step. These can include:

• Pantoprazole (Protonix®).
• Rabeprazole (Aciphex®).
• Esomeprazole (Nexium®).
• Omeprazole (Prilosec®).
• Lansoprazole (Prevacid®).

When is surgery for a hiatal hernia needed?

If the portion of the stomach entering the esophagus is being squeezed so tightly that the blood supply is being cut off, you’ll need to have surgery. Surgery may also be needed in people with a hiatal hernia who have severe, long-lasting (chronic) esophageal reflux whose symptoms are not relieved by medical treatments. The goal of this surgery is to correct gastroesophageal reflux by creating an improved valve mechanism at the bottom of the esophagus. Think of this valve as a swinging door. It opens to let food pass down into the stomach and then closes to keep stomach contents from going back up the esophagus. When this valve doesn’t work correctly, your stomach contents can go the wrong way and damage your esophagus. If left untreated, chronic gastroesophageal reflux can cause complications such as esophagitis (inflammation), esophageal ulcers, bleeding or scarring of the esophagus.

How is surgery for a hiatal hernia performed?

Surgery for repairing a hiatal hernia involves:

• Pulling the hiatal hernia back into the abdomen.
• Improving the valve at the bottom of the esophagus.
• Closing the hole in the diaphragm muscle.

During surgery, your surgeon will wrap the upper part of the stomach (called the fundus) around the lower portion of the esophagus. This creates a permanently tight sphincter (the valve) so that stomach contents will not move back (reflux) into the esophagus.

Called a fundoplication, there are two versions of this surgery. An open fundoplication surgery involves a larger incision. This type of procedure may need to be done in some very severe cases and it allows for greater visibility during surgery. However, open surgeries require a longer recovery time in the hospital. In many cases, the surgeon will decide to use a laparoscopic approach instead.

A laparoscopic surgery is done through several small incisions instead of one big cut. This is considered a minimally invasive option. The specific laparoscopic procedure used to repair a hiatal hernia is called the Nissen fundoplication. This procedure creates a permanent solution to your hiatal hernia symptoms. During the procedure, your surgeon will make five or six tiny incisions in the abdomen. The laparoscope (a tool that allows the surgical team to see your internal organs on a screen in the operating room) and other surgical instruments are inserted through the small incisions. The fundus is wrapped around the esophagus and the sphincter is tightened during surgery. The advantages of laparoscopic surgery compared to an open surgery include:

• Smaller incisions.
• Less risk of infection.
• Less pain and scarring.
• A shorter recovery.

Outlook / Prognosis

How effective is surgery for a hiatal hernia?

A laparoscopic repair of hiatal hernia and reflux, called Nissen Fundoplication, is very effective in most patients. This surgery requires general anesthesia and a short stay in the hospital. If you need to have an open surgical procedure, the recovery time will be longer and you may need to stay in the hospital for several days. After surgery, most patients no longer require long-term treatment with prescription or over-the-counter antacid medications.

Hiatal Hernia

Overview

The esophagus sphincter muscle normally closes tightly. With a hiatal hernia, the sphincter’s new position may keep it from completely closing. The back flow of digestive juices may damage the esophagus.

What is a hiatal hernia?

A hiatal hernia occurs when the upper part of the stomach pushes through an opening in the diaphragm and into the chest cavity. The diaphragm is the thin muscle wall that separates the chest cavity from the abdomen. The opening in the diaphragm is where the esophagus and stomach join.

Who is at risk for developing a hiatal hernia?

A hiatal hernia can develop in people of all ages and both sexes, although it frequently occurs in people age 50 and older. Hiatal hernia occurs more often in overweight people and smokers.

Symptoms and Causes

What causes a hiatal hernia?

The most common cause of a hiatal hernia is an increase in pressure in the abdominal cavity. Your abdominal cavity is the space in the middle of your body that holds several organs, including the:

• Lower part of the esophagus and stomach.
• Small intestine, colon and rectum.
• Liver.
• Gallbladder, pancreas and spleen.
• Kidneys.
• Bladder.

This pressure can build up from things like:

• Coughing.
• Vomiting.
• Straining during a bowel movement.
• Heavy lifting.
• Physical strain.

There are also other reasons a hiatal hernia could develop. You may experience a hiatal hernia during pregnancy, if you are obese, or if there’s extra fluid in your abdomen.

Increased pressure in the abdomen (arrows) causes part of the stomach to push through the diaphragm and into the chest cavity.

What are the symptoms of a hiatal hernia?

Many people with a hiatal hernia never have symptoms. Some people with hiatal hernia have some of the same symptoms as gastroesophageal reflex disease (GERD). GERD occurs when digestive juices move from the stomach back into the esophagus. Symptoms of GERD include:

• Heartburn.
• Bitter or sour taste in the back of the throat.
• Bloating and belching.
• Discomfort or pain in the stomach or esophagus.

Although there appears to be a link between hiatal hernia and GERD, one condition does not seem to cause the other. Many people have a hiatal hernia without having GERD, and others have GERD without having a hiatal hernia.

Another symptom of a hiatal hernia is chest pain. Since chest pain can also be a symptom of a heart attack, it’s important to contact your healthcare provider or go to the emergency room if you experience any chest pain.

Diagnosis and Tests

How is a hiatal hernia diagnosed?

Several tests can be done to help diagnose a hiatal hernia. These include a barium swallow test, an endoscopy procedure, esophageal manometric studies, a pH test and gastric emptying studies.

• A barium swallow involves drinking a special liquid, then taking X-rays to help see problems in the esophagus (such as swallowing disorders) and the stomach (such as ulcers and tumors). It also shows how big the hiatal hernia is and if there is twisting of the stomach as a result of the hernia.
• An endoscopy is a procedure in which the inside of the upper digestive system is viewed with an endoscope (a long, thin, flexible instrument about 1/2 inch in diameter).
• An esophageal manometry measures the strength and muscle coordination of your esophagus when you swallow.
• A pH test measures the acid levels in the esophagus and helps determine which symptoms are related to acid in the esophagus.
• Gastric emptying studies examine how fast food leaves the stomach. Results from this test are especially important in patients who have nausea and vomiting. There could be other causes of the nausea and vomiting besides a hiatal hernia.

Management and Treatment

How is a hiatal hernia treated?

Most hiatal hernias do not cause problems and rarely need treatment. However, since some patients with a hiatal hernia have symptoms of GERD, treatment starts with methods used to manage GERD. These include making such lifestyle changes as:

• Losing weight if you’re overweight.
• Decreasing the portion sizes of meals.
• Avoiding certain acidic foods—such as tomato sauce and citrus fruits or juices—that can irritate the esophageal lining.
• Limiting fried and fatty foods, foods or drinks containing caffeine (including chocolate), peppermint, carbonated beverages, alcoholic beverages, ketchup and mustard, and vinegar.
• Eating meals at least three to four hours before lying down, and avoiding bedtime snacks.
• Keeping your head six inches higher than the rest of your body when lying on your back. Raising the level of your head helps gravity keep your stomach’s contents in the stomach. Raising the head of your bed by angling your mattress works best—piling your pillows doesn’t work as well because it makes you crunch your middle instead of simply angling your body upwards.
• Quitting smoking.
• Not wearing a tight belt or tight clothing that can increase the pressure on the abdomen — such as control top hosiery and body shapers.
• Taking medications after eating to reduce acid in the stomach. These over-the-counter medications include antacids, Gaviscon®, or H-blockers (such as Pepcid AC® or Zantac®).

Sometimes, a medication called a proton-pump inhibitor might be used to treat hiatal hernia. This medication is another way to decrease the amount of stomach acid you have, which can help prevent reflux. When you take this medication, your body doesn’t make as much stomach acid as normal. This is similar to H-blocker medications.

Can over-the-counter medications help relieve my hiatal hernia symptoms?

In many cases, over-the-counter medications can help you with some symptoms of hiatal hernia. Antacids are the most common medication you might use for relief. However, if you take over-the-counter medications for longer than two weeks without any improvement, see your healthcare provider. Prescription medications are typically the next step. These can include:

• Pantoprazole (Protonix®).
• Rabeprazole (Aciphex®).
• Esomeprazole (Nexium®).
• Omeprazole (Prilosec®).
• Lansoprazole (Prevacid®).

When is surgery for a hiatal hernia needed?

If the portion of the stomach entering the esophagus is being squeezed so tightly that the blood supply is being cut off, you’ll need to have surgery. Surgery may also be needed in people with a hiatal hernia who have severe, long-lasting (chronic) esophageal reflux whose symptoms are not relieved by medical treatments. The goal of this surgery is to correct gastroesophageal reflux by creating an improved valve mechanism at the bottom of the esophagus. Think of this valve as a swinging door. It opens to let food pass down into the stomach and then closes to keep stomach contents from going back up the esophagus. When this valve doesn’t work correctly, your stomach contents can go the wrong way and damage your esophagus. If left untreated, chronic gastroesophageal reflux can cause complications such as esophagitis (inflammation), esophageal ulcers, bleeding or scarring of the esophagus.

How is surgery for a hiatal hernia performed?

Surgery for repairing a hiatal hernia involves:

• Pulling the hiatal hernia back into the abdomen.
• Improving the valve at the bottom of the esophagus.
• Closing the hole in the diaphragm muscle.

During surgery, your surgeon will wrap the upper part of the stomach (called the fundus) around the lower portion of the esophagus. This creates a permanently tight sphincter (the valve) so that stomach contents will not move back (reflux) into the esophagus.

Called a fundoplication, there are two versions of this surgery. An open fundoplication surgery involves a larger incision. This type of procedure may need to be done in some very severe cases and it allows for greater visibility during surgery. However, open surgeries require a longer recovery time in the hospital. In many cases, the surgeon will decide to use a laparoscopic approach instead.

A laparoscopic surgery is done through several small incisions instead of one big cut. This is considered a minimally invasive option. The specific laparoscopic procedure used to repair a hiatal hernia is called the Nissen fundoplication. This procedure creates a permanent solution to your hiatal hernia symptoms. During the procedure, your surgeon will make five or six tiny incisions in the abdomen. The laparoscope (a tool that allows the surgical team to see your internal organs on a screen in the operating room) and other surgical instruments are inserted through the small incisions. The fundus is wrapped around the esophagus and the sphincter is tightened during surgery. The advantages of laparoscopic surgery compared to an open surgery include:

• Smaller incisions.
• Less risk of infection.
• Less pain and scarring.
• A shorter recovery.

Outlook / Prognosis

How effective is surgery for a hiatal hernia?

A laparoscopic repair of hiatal hernia and reflux, called Nissen Fundoplication, is very effective in most patients. This surgery requires general anesthesia and a short stay in the hospital. If you need to have an open surgical procedure, the recovery time will be longer and you may need to stay in the hospital for several days. After surgery, most patients no longer require long-term treatment with prescription or over-the-counter antacid medications.

Five Symptoms That Point to a Hernia | Press

Five Symptoms That Point to a Hernia

Do I Have a Hernia? Five Symptoms That Point to Yes

An estimated 20 million hernia repairs are performed globally every year according to the National Center for Biotechnology Information. Most people have heard of this common condition, but not everyone understands what a hernia is and how to recognize one. In the simplest terms, a hernia occurs when an organ pushes through something it shouldn’t, like muscle or tissue. 

All hernias are caused by this combination of pressure and an opening, but hernias can appear in different parts of the body. Common places include the outer groin, belly button, upper stomach or through an abdominal incision or scar. However, more than 70 percent of hernias occur in the inner groin and are referred to as inguinal hernias, which are 25 times more likely to affect men than women.

Hernia symptoms can appear gradually or suddenly and cause varying degrees of pain or discomfort. Although symptoms may differ by individual or type of hernia, some frequent indicators include:

1.  A noticeable bulge or lump
A bulge is the most common hernia symptom. It can sometimes be pushed back in or disappear when lying down. Often located in the groin or scrotum, the bulge can increase in size over time and cause aches or pain at the site. 

2.  Pain or discomfort when coughing, straining or lifting 
Experiencing pain when coughing or sneezing, lifting heavy objects, or even when laughing or crying can be a sign of a hernia. Usually, this discomfort will be felt in the lower abdominal area.

3.  Acid reflux or difficulty swallowing
Frequent heartburn, indigestion and regurgitation can be indicators of a hiatal hernia. This type of hernia occurs when part of the stomach protrudes up through the diaphragm and stomach acids leak into the esophagus. 

4.  Feeling full or constipated
When a section of the intestine has become trapped, feeling bloated or full and being constipated can indicate a hernia caused by a bowel blockage. These symptoms usually develop rapidly and are accompanied by a feeling of heaviness in the abdomen.

5.  Severe pain, nausea and vomiting
When a portion of the intestine becomes so firmly wedged against the abdominal wall that it cuts off the blood supply, a strangulated hernia occurs. It is accompanied by severe pain, nausea, vomiting and constipation, and could be life-threatening. You should seek immediate medical attention if you experience these types of intense symptoms. 

An untreated hernia in adults will not go away, but the good news is hernias are treatable. If you are not experiencing any pain or complications, your doctor may choose to simply watch the hernia to make sure it does not cause further problems. If your hernia is growing larger or causing pain; however, your doctor may recommend surgery to repair the opening. 

To lessen your chances of getting a hernia, consider not smoking, maintaining a healthy body weight, avoid straining during bowel movements, using good form when lifting objects or heavy weights, and seeing a doctor for chronic coughs or constipation.

If you experience any of these hernia symptoms, make an appointment with your physician. With an early diagnosis or lifestyle changes, you can avoid serious complications.

Hiatal Hernia | Cedars-Sinai

Not what you’re looking for?

What is a hiatal hernia?

A
hernia is when part of an organ goes through an opening in the muscle wall around
it.

In a
hiatal hernia, part of your stomach pushes up into an opening (the hiatus) in your
diaphragm. The diaphragm is the muscle between your belly (abdomen) and your chest.

In most cases, your food pipe (esophagus) goes through the hiatus and joins your stomach.
But with a hiatal hernia, the top part of your stomach moves up through that opening
into your chest.

The top part of your stomach gets pinched. Stomach acid can back up (reflux) through
the opening. This may cause heartburn and other symptoms.

There are two types of hiatal hernias: sliding and paraesophageal.

Sliding hiatal hernia

This type of hernia:

• Is
  most common
• Happens when part of the stomach and the place where the stomach and esophagus
  meet slide up into your chest through the opening (hiatus)

Paraesophageal hernia

This type of hernia:

• Is
  less common but can be more serious
• Happens when part of your stomach pushes up through the opening (hiatus) into
  your chest and is next to your esophagus

What causes a hiatal hernia?

Experts don’t know what causes hiatal hernias. Some causes may include:

• Coughing
• Vomiting
• Straining while having a bowel movement
• Sudden physical effort
• Pregnancy
• Obesity

Who is at risk for a hiatal hernia?

You may be at greater risk for a hiatal hernia if you:

• Are age
  50 or older
• Are overweight or obese
• Are pregnant
• Smoke

What are the symptoms of a hiatal hernia?

In
many cases, a hiatal hernia has no symptoms.

Some people do have symptoms. These may include:

• Burping
• Feeling nauseous
• Vomiting
• Backflow (reflux) of acid or stomach contents into the esophagus or throat
• Heartburn
• Regurgitation
• Trouble swallowing

Paraesophageal hernias may have more severe symptoms. These can include:

• Having trouble swallowing sometimes, most often with solid foods
• Feeling full after eating only a small amount of food
• Belly (abdominal) or chest pain
• Abdominal bleeding
• Blood loss (anemia)

In
some cases, a paraesophageal hernia can lead to a medical emergency. The stomach or
abdominal organs may turn or twist, causing very bad pain. There is a danger that
the
stomach’s blood supply may be cut off (strangulation). This is an emergency. You will
likely need surgery right away.

The symptoms of a hiatal hernia may look like other health problems. Always see your
healthcare provider to be sure.

How is a hiatal hernia diagnosed?

Your
healthcare provider will give you a physical exam. They will look at your past
health.

You
may also have tests, including:

• Chest
  X-ray.
  This may show that you have a hiatal hernia.
• Upper
  endoscopy, also called EGD (esophagogastroduodenoscopy).
  This test looks at
  the lining of your food pipe (esophagus), stomach, and the first part of your small
  intestine (the duodenum). It uses a thin, lighted tube called an endoscope. The tube
  has a camera at one end. The tube is put into your mouth and throat while you are
  sedated. Then it goes into your esophagus, stomach, and duodenum. Your healthcare
  provider can see the inside of these organs.
• Upper GI
  (gastrointestinal) series or barium swallow.
  This test looks at the organs of
  the top part of your digestive system. It checks your food pipe (esophagus), stomach,
  and the first part of your small intestine (the duodenum). You will swallow a
  metallic fluid called barium. Barium coats the inside of the esophagus, stomach, and
  intestines so that they can be seen on an X-ray. 
• Esophageal
  manometry.
  This test checks the strength of your esophagus muscles. It can
  see if you have any problems with reflux or swallowing. A small tube is put into your
  nostril, then down your throat into your esophagus. This measures the pressure that
  your esophagus muscles make at rest and during swallowing.

How is a hiatal hernia treated?

Treatment will depend on your symptoms, age, and general health. It will also depend
on
how severe the condition is.

In
most cases, you won’t need treatment. But you may need medical care if your hernia:

• Is at
  risk of being twisted so much that blood supply is cut off to your stomach
  (strangulation)
• Is more
  difficult because of severe GERD (gastroesophageal reflux disease)
• Is more
  difficult because of redness and swelling (inflammation) of your esophagus
  (esophagitis)

Your
healthcare provider may suggest medicines to:

• Weaken
  or neutralize stomach acid (antacids)
• Reduce
  the amount of acid your stomach makes (H-2 blockers or proton pump inhibitors)
• Strengthen your lower esophageal sphincter (LES), the muscle that stops stomach acid
  from backing up into your esophagus

In
severe cases, surgery may also be needed to:

• Make
  your hernia smaller
• Stop
  loss of blood flow to your stomach (strangulation) by closing the opening in your
  diaphragm

What are possible complications of
a hiatal hernia?

In
most cases, a hiatal hernia won’t lead to other health problems.

In
some cases, it can cause other problems such as:

• Severe GERD (gastroesophageal reflux disease)
• Lung
  problems or pneumonia because stomach contents have moved up into your esophagus and
  into one or both lungs
• Strangulation of the hernia, cutting off blood flow to your stomach (medical
  emergency)

What can I do to prevent a hiatal hernia?

Health experts don’t know what causes hiatal hernias. They don’t know how to stop
them from happening.

Living with a hiatal hernia

Follow your healthcare provider’s advice for treating and managing your hiatal hernia.
You may need to make some lifestyle changes, such as:

• Losing
  weight if you are overweight or obese
• Not
  eating for 3 to 4 hours before going to bed
• Not
  bending over right after eating
• Quitting
  smoking
• Elevating the head of your bed while you sleep

When should I call my healthcare provider?

Call your healthcare provider if your
symptoms come back after treatment has stopped them. Let your healthcare provider
know
if symptoms get worse or you have new symptoms.

Key points about hiatal
hernia

• A hiatal hernia is when part of your stomach pushes up into an opening (the hiatus)
  in your diaphragm.
• There
  are two types of hiatal hernias: sliding and paraesophageal.
• Paraesophageal hernias are less common but can be more serious. You may need surgery.
• Experts don’t know what causes hiatal hernias.
• In most
  cases, there are no symptoms.
• In most
  cases, no medical care is needed.

Next steps

Tips to help you get the most from a visit to your health care
provider:

• Know the reason for your visit and what you want to happen.
• Before your visit, write down questions you want answered.
• Bring someone with you to help you ask questions and remember
  what your provider tells you.
• At the visit, write down the name of a new diagnosis and any new
  medicines, treatments, or tests. Also write down any new instructions your provider
  gives you.
• Know why a new medicine or treatment is prescribed and how it
  will help you. Also know what the side effects are.
• Ask if your condition can be treated in other ways.
• Know why a test or procedure is recommended and what the results
  could mean.
• Know what to expect if you do not take the medicine or have the
  test or procedure.
• If you have a follow-up appointment, write down the date, time,
  and purpose for that visit.
• Know how you can contact your provider if you have questions.

Medical Reviewer: Jen Lehrer MD

Medical Reviewer: Ronald Karlin MD

Medical Reviewer: Raymond Kent Turley BSN MSN RN

© 2000-2021 The StayWell Company, LLC. All rights reserved. This information is not intended as a substitute for professional medical care. Always follow your healthcare professional’s instructions.

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Paraesophageal Hernia (Hiatal Hernia) | Minimally Invasive and Gastrointestinal Surgery

What is a hiatal hernia?
Any time an internal body part pushes into an area where it doesn’t belong, it’s called a hernia. The hiatus is an opening in the diaphragm – the muscular wall separating the chest cavity from the abdomen. Normally, the esophagus goes through the hiatus and attaches to the stomach. In a hiatal hernia, the stomach bulges up into the chest through that opening. There are two main types of hiatal hernias: sliding and paraesophageal (next to the esophagus).

In a sliding hiatal hernia, the stomach and the section of the esophagus that joins the stomach slide up into the chest through the hiatus. This is the more common type of hernia. These sliding hiatal hernias are a risk factor for gastroesophageal reflux disease (GERD), and many patients with hiatal hernias suffer from GERD symptoms such as heartburn. Sliding hiatal hernias are very common and as many as more than 1 in 4 adults has one by the time they reach the age of 40.

The paraesophageal hernia is less common but is more cause for concern. In many patients, paraesophageal hernias may not cause any symptoms. These asymptomatic paraesophageal hernias can be safely observed and do not require surgery. When a paraesophageal hernia begins to cause symptoms (chest pain, upper abdominal pain, difficulty swallowing), these are usually repaired. Symptomatic paraesophageal hernias are at higher risk for progressing to incarceration (stomach gets stuck resulting in obstruction) or ischemia (blood supply to the stomach is cut off) resulting in the need for emergency surgery.

When should a sliding hiatal hernia be repaired?
Hiatal hernias are known to contribute to GERD. When diet, lifestyle modifications (lose weight, don’t eat late at night, sleep upright), and acid reduction medications fail to adequately control symptoms, hiatal hernia repair may be indicated. See our web page on GERD for more information.

When should a paraesophageal hernia be repaired?
In general, all paraesophageal hernias causing symptoms should be repaired. Common symptoms from a paraesophageal hernia include:

• Chest pain—there are many causes for chest pain. It is important that patients who have a large paraesophageal hernia with chest pain undergo some kind of a cardiac evaluation to make sure that the chest pain is not from their heart. Typically, eating brings on chest pain from a paraesophageal hernia. Some patients have pain every time they eat, and others only experience discomfort every once in a while.
• Epigastric pain—this is pain in the middle, upper abdomen.
• Dysphagia—difficulty swallowing.
• Shortness of breath—in some very large paraesophageal hernias, the stomach may push on the diaphragm or compress the lungs contributing to a sensation of shortness of breath. There are many other reasons for shortness of breath in addition to a paraesophageal hernia.
• Early or prolonged satiety—Because the stomach is twisted or compressed due to the hernia, it may be difficult for patients to eat a normal sized meal. Patients may feel full for a very long time after eating, which is due to the fact that the stomach can’t empty normally when it is herniated. Some patients may lose weight because of difficulty eating.
• Stomach ulcer—in some patients with paraesophageal hernias, the stomach may twist upon itself resulting in a specific kind of stomach ulcer known as a Cameron’s erosion. These ulcers can occasionally contribute to chronic slow blood loss and anemia.

Many patients (but not all) with paraesophageal hernias may also suffer from gastroesophageal reflux disease symptoms. GERD by itself is not a reason to repair a paraesophageal hernia. GERD is first treated with medications, and surgery is reserved for those who fail medical management.

For an in-depth discussion on whether a paraesophageal hernia should be repaired, please make an appointment with one of our surgeons.

Can a paraesophageal or a hiatal hernia cause pain in my back?
A sliding hiatal hernia will not cause back or epigastric pain like a paraesophageal hernia can. Sliding hiatal hernias can cause GERD symptoms. A very large paraesophageal hernia could potentially cause back pain, but this is not a common symptom. The most common pains related to a paraesophageal hernia are chest and epigastric (upper abdomen) pain, most often during or shortly following eating.

How are paraesophageal hernias repaired?
Almost all paraesophageal hernias can successfully and safely be repaired laparoscopically (with about 5 very small incisions) and through the abdomen (rather than the chest cavity). The laparoscopic repair of large paraesophageal hernias (most of the stomach resides above the diaphragm in the chest cavity) is a complex procedure and should only be attempted by expert laparoscopic surgeons with extensive experience in laparoscopic foregut surgery.

During surgery, the stomach is gradually moved back into the abdominal cavity. The diaphragm at the esophageal hiatus is closed to prevent the stomach from re-herniating. In some cases, a special kind of mesh is needed to close the diaphragm appropriately. Once the diaphragm has been closed, most patients undergo a fundoplication or a ‘wrap’ similar to what is done for a patient with GERD. The fundoplication is performed to help keep the stomach from herniating back into the chest cavity.

What are the results of paraesophageal hernia repair?
In the hands of experienced surgeons, the results of laparoscopic paraesophageal hernia repair are excellent. A minimally invasive laparoscopic approach results in significantly fewer complications than an open abdominal approach (many small incisions instead of one large incision in an open approach). Most patients are in the hospital for only 1-2 days and are back to their usual activities within 4 weeks.

Side effects can occur and are similar to those observed after laparoscopic Nissen fundoplication. Abdominal bloating can occur but is rarely severe. Difficulty swallowing (dysphagia) is another side effect that tends to improve in most patients with time – provided food is chewed thoroughly. The majority of patients are able to belch easily when necessary; especially once some time has passed following surgery.

For a more detailed discussion about the options, risks, and outcomes of paraesophageal hernia repair, and to determine if a patient is a candidate for a laparoscopic repair, please make an appointment with a fellowship trained minimally invasive gastrointestinal surgeon in the Division of Minimally Invasive and Gastrointestinal Surgery at the Medical College of Wisconsin.

“Elective Repair of Paraesophageal Hernia is Safe”

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Hernia of the esophageal opening of the diaphragm – diagnostics, clinical recommendations, prices for treatment in the clinic St. Petersburg

Diaphragmatic hernia is a congenital or acquired defect of the diaphragm, that is, a hernial opening through which the abdominal organs move into the chest – the stomach, intestinal loops, spleen, part of the liver.

Causes of hernia

• Injury – penetrating wounds to the abdomen or chest, impacts.
• Underdevelopment of the diaphragm during embryonic development.
• Increased intra-abdominal pressure – dry cough, persistent constipation, frequent childbirth, multiple pregnancies.
• Older age – the tone of the diaphragm changes after 60 years.
• Chronic gastrointestinal diseases – pancreatitis, peptic ulcer, esophagitis.
• Incorrect innervation of the diaphragm.

Depending on the cause of the appearance, diaphragmatic hernias are classified into three types:

• congenital;
• neuropathic;
• traumatic.

Symptoms

Small hernias of the diaphragm may not show symptoms for a long time and may be accidentally detected on examination of another organ.
Large hernial sacs containing internal organs usually have a fairly clear clinical picture.

Symptoms in newborns:

• Sleep disturbance, irritability;
• shortness of breath after eating;
• vomiting, frequent regurgitation;
• blue skin.

Symptoms in adults:

• belching with air;
• bloating;
• pain behind the sternum due to the fact that the organs of the gastrointestinal tract are compressed in the hernial sac;
• heartburn after eating, when bending forward;
• Difficulty breathing because the mediastinum and lung are displaced to the healthy side.

If the disease proceeds with complications, then bleeding from the hernial sac begins, the mucous membrane of the esophagus becomes inflamed.
Dangerous to life when stomach or intestines are impaired. In this case, the patient feels severe chest pain, vomits, stool retention is observed, and the general condition worsens. If you do not provide medical care in time, then peritonitis will begin, often leading to death.

Diagnostic methods

The “gold standard” for diagnosing this disease is chest x-ray with contrast. Additionally, EGD, MRI or CT can be prescribed.

Complications of the disease

Diaphragmatic hernia can cause the following complications:

• esophageal bleeding;
• narrowing of the esophagus;
• reflux esophagitis;
• reflex angina pectoris;
• entrapment of organs in the hernial sac, followed by peritonitis;
• peptic ulcer of the stomach, esophagus;
• perforation of the esophagus.

Treatment without surgery

In mild cases, conservative therapy is possible. It is performed with a small hernial sac and a reduced risk of organ entrapment. Patients are prescribed antacids to relieve heartburn, and antispasmodics to relieve pain. fractional meals are recommended – 5-6 times a day in small portions. The diet should contain fresh, well-cooked food. Smoking is prohibited, spicy, salty, because all this increases the production of hydrochloric acid in the stomach.

Surgical treatment

The operation is needed when the hernia of the diaphragm reaches a large size, as well as in case of ineffectiveness of conservative therapy and infringement of internal organs.

The operation consists in removing the hernial sac and suturing the hernial opening. In some cases, a mesh implant is placed on the diaphragm defect.

Postoperative period

The patient spends about 3 days in the hospital. After discharge, you must follow the diet prescribed by your doctor, do not expose yourself to heavy loads.Full recovery after surgery takes 1-1.5 months.

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Hernia of the esophageal opening of the diaphragm – (Clinic Di Center)

Hernia of the esophageal opening of the diaphragm

A hiatal hernia is a displacement into the chest cavity through the esophageal opening of the diaphragm of the lower part of the esophagus, part of the stomach, and sometimes intestinal loops.Normally, the ligamentous apparatus of the esophageal opening of the diaphragm, subphrenic adipose tissue and the natural anatomical arrangement of the abdominal organs prevent the movement of organs lying under the diaphragm into the chest cavity. The disease promotes the throwing of acidic stomach contents into the esophagus, so heartburn is its main symptom. A hernia exists in every twentieth adult, and over the age of 50 – in every second.

What are the causes of a hernia?

The cause of a hernia may be a weakening of the ligamentous apparatus.It is present in 5% of the entire adult population and in about 50% over the age of 50 (age-related weakening of the ligamentous apparatus), more often found in untrained, asthenic people. Another factor provoking the development of this disease is a significant increase in intra-abdominal pressure due to severe flatulence, pregnancy, trauma or large tumors of the abdominal cavity, bouts of indomitable vomiting or persistent cough (for example, in patients with chronic obstructive bronchitis).Dyskenisia (disturbances of peristalsis) of the digestive tract, in particular the esophagus, which are often observed against the background of chronic inflammatory diseases, gastric ulcer and duodenal ulcer, gastroduodenitis, pancreatitis, cholecystitis), can also lead to the development of a hernia. In rare cases, it is caused by malformations of embryonic development (short esophagus, pectoral stomach).

What are the symptoms?

A hernia of the esophageal opening of the diaphragm leads to insufficiency of the obturator mechanisms located at the border of the stomach and esophagus, which means that it provokes the throwing of the acidic contents of the stomach into the esophagus and the development of reflux esophagitis.A small hernia may not show any symptoms and is usually detected during a diagnostic examination associated with another disease.

In cases where the hernia is large, but the obturator mechanisms at the border of the esophagus and stomach are still functioning adequately, the main manifestation of the disease is pain in the chest, in the heart or in the epigastric region. Pain occurs immediately after eating, when lifting weights or against a background of stress, and can last from several minutes to several days.Dysphagia (violation of food swallowing) is often noted. If the hernial sac is compressed, then there are dull aching pains in the epigastric or epigastric region or behind the sternum.

In case of insufficiency of the obturator mechanisms, the main symptom of a hiatal hernia is heartburn. It occurs after eating, a sharp change in body position, more often at night, which is explained by an increase in the tone of the vagus nerve. Starting as burning heartburn, discomfort can turn into painful sensations.

What complications can a hernia cause?

A hernia of the esophageal opening of the diaphragm can indeed cause coronary pain due to irritation of the vagus nerve and subsequent spasm of the coronary vessels of the heart, this situation is fraught with the development of serious cardiovascular complications up to myocardial infarction. Another extremely unpleasant symptom is belching of stomach contents or air. If a large volume of gastric contents is regurgitated, especially at night, this can lead to the development of aspiration pneumonia.Regurgitation is not preceded by nausea or stomach contractions; it occurs by contraction of the esophagus.

Diagnostic examinations

Diagnosis of a hiatal hernia is difficult, since its symptoms are very diverse, it is often combined with other diseases of the gastrointestinal tract and proceeds with complications. No wonder this disease is figuratively called “masquerade of the upper abdomen.” To make a diagnosis, an X-ray of the esophagus is performed with barium sulfate construction, the motility of the esophagus is examined using esophagomanometry, and daily pH-metry is performed.

Hernia treatment and prevention

Since the clinical picture of the disease in the overwhelming majority of cases is determined by reflux of gastric contents, then the treatment is the same as for reflux esophagitis.

In severe cases and if drug therapy is unsuccessful, surgical treatment is performed (suturing the hernial orifice, strengthening the esophageal-phrenic ligament, various methods of fixing the stomach in the abdominal cavity, fundoplication).After completing the main course of treatment, all patients should be registered with a gastroenterologist.

Diaphragmatic hernia – symptoms, modern methods of diagnosis and treatment

A hernia of the esophageal opening of the diaphragm (diaphragmatic hernia) occurs if through the esophageal opening of the diaphragm – the opening through which the esophagus from the chest cavity enters the abdominal – the abdominal part of the esophagus, part of the stomach or the abdominal part of the esophagus, together with part of the stomach, is displaced into the chest cavity.Sometimes, through the esophageal opening of the diaphragm, other organs located in the abdominal cavity can be displaced into the chest cavity.

At the onset of the disease, the displacement of the abdominal cavity organs into the chest cavity occurs periodically, under the influence of physical exertion, coughing, vomiting, overeating, etc. Then such loss becomes more frequent or permanent. The most common hernia is axial or sliding. In this case, the abdominal part of the esophagus or the end of the esophagus with a part of the stomach falls into the esophageal opening of the diaphragm.

Causes of the disease

The cause of a diaphragmatic hernia is the increased elasticity of the tissues limiting the esophageal opening of the diaphragm. This elasticity can be innate. Sometimes there is a developmental anomaly – the so-called “short esophagus with a pectoral stomach.” But more often a hernia occurs during the patient’s life under the influence of conditions that contribute to an increase in intra-abdominal pressure: hard physical labor, obesity, ascites (accumulation of fluid in the abdominal cavity), endocrine diseases.Sometimes pregnancy leads to a hiatal hernia. The weakening and thinning of the ligaments and connective tissue with age matters.

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Symptoms of the disease

One of the most common complaints is heartburn (caused by reflux of gastric contents into the esophagus).With a hernia of the diaphragm, heartburn often occurs at night or after eating. Heartburn can also occur after exercise, and is often accompanied by pain.

Pain with a hiatal hernia occurs in 40-50% of patients. The pain is quite intense, it is felt retrosternal, has a burning character and, therefore, is often confused by patients with pain with angina pectoris. Pain with a hernia of the esophagus is most often associated with bending, physical exertion and is aggravated in the supine position.When the position of the body changes, the pain often subsides.

The next common symptom of a hiatal hernia is belching. Belching – involuntary sudden release of gas through the mouth from the stomach or esophagus, sometimes with an admixture of stomach contents, occurs in 30 – 73% of patients. Regurgitation occurs with gastric contents or air. Belching is usually preceded by a feeling of fullness in the epigastric region. This condition occurs after eating or during a conversation.Taking antispasmodics can be ineffective; only belching with a significant amount of food brings relief.

Difficulty passing food through the esophagus with a hiatal hernia is intermittent. It is often provoked by the intake of very cold or, on the contrary, very hot food, as well as by nervous overload. The constant nature of the difficulty in passing food through the esophagus should alert to complications.

Complications

A complication of a hiatal hernia is most often reflux esophagitis, but a peptic ulcer of the esophagus can develop, with a prolonged course of which, in turn, cicatricial stenosis (narrowing) of the esophagus can occur.There are acute and chronic bleeding from the esophagus, perforation of the esophagus or infringement of a hernia in the esophageal opening of the diaphragm.

Diagnostics

The diagnosis of a hiatal hernia is made by X-ray examination. Conventional fluoroscopy of the esophagus and stomach with barium contrast is often sufficient. To clarify the diagnosis, esophagogasroscopy is performed.

Treatment

A diet with fractional meals in small portions is prescribed, treatment of constipation.Physiotherapy is mandatory. Doing certain exercises can help prevent stomach displacement. Drugs are used to reduce gastric secretion and reduce acid aggressiveness of gastric contents, normalize dyskinesias of the gastrointestinal tract.

The occurrence of complications of a hiatal hernia is an indication for the appointment of surgical treatment.

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Advantages of the Hospital Center

Individual treatment regimen for each patient

For each patient, without fail, even at the prehospital stage, an individual treatment regimen is developed, taking into account all the characteristics of the body: age, health status, medical history, etc.- this approach allows you to minimize risks both during the operation and in the postoperative period, and as a result, to ensure the fastest possible rehabilitation with a minimum period of hospitalization.

Multidisciplinary approach

The medical staff of the Hospital Center is a single team made up of doctors – experts of different specializations, which allows for a multidisciplinary approach.We treat a patient, seeing in front of us not a list of the diseases he has, but a person whose problems are interrelated and interdependent. The therapeutic measures taken are always aimed at improving the overall health, well-being and quality of life of the patient, and are not limited to eliminating the symptoms of a specific disease.

Surgical treatment of any level of complexity

The operating doctors of the Hospital Center possess advanced and high-tech methods of performing operations.The combination of highly qualified doctors and innovative equipment allows for surgical treatment of the highest level of complexity.

High-tech, minimally invasive treatment methods

The basis of the methodology of treatment carried out in the Hospital Center is the principles of minimizing risks for the patient and the fastest possible rehabilitation.

Implementation of such an approach is possible only with the use of the most high-tech techniques, modern equipment and the application of the latest achievements of medical science.

The qualification of doctors in combination with modern equipment allows us to successfully implement this approach to treatment.

Fast-track surgery

Fast-track is a comprehensive technique that allows you to minimize the patient’s stay in the hospital without compromising the quality of treatment.

The approach is based on minimizing surgical trauma, reducing the risk of postoperative complications and accelerating recovery after surgery, which ensures our patients have a minimum hospital stay.

Even such complex operations as, for example, cholecystectomy, thanks to this approach, require a hospital stay of no more than 3 days.

Personal medical supervision in the postoperative period

To completely exclude the development of possible complications, the early postoperative period, all patients, regardless of the complexity of the operation, are carried out in the intensive care unit under the individual supervision of an intensive care physician.

Transfer of the patient to the ward is carried out only in the complete absence of even the smallest possible risks.

Informing relatives 24/7

We are as open as possible and take care not only of the patient, but also of his loved ones. Patient health information is provided to relatives seven days a week, 24 hours a day.

Visiting patients is also possible at any convenient time.

Highly comfortable single and double rooms

At the service of patients are spacious comfortable wards for single and double occupancy, equipped with everything necessary for rest and recovery.

In the pediatric department, our little patients are accommodated together with their parents.

Tax deduction

According to the tax legislation of the Russian Federation, each patient has the right to compensation up to 13% of the amount spent by him for his treatment, as well as the treatment of close relatives.

Our specialists will prepare for you a package of documents for the tax office for a refund of 13% of the cost of treatment, as well as give recommendations on various ways of interacting with the tax office.

Contacts

+7 (499) 583-86-76

Moscow, Bakuninskaya street, building 1-3
Nearest metro station: Baumanskaya

Hernia of the esophageal opening of the diaphragm (HH) and Gastroesophageal reflux disease (GERD)

Heartburn is one of the main symptoms of hiatal hernia and gastroesophageal reflux disease.Heartburn appears after eating and is often aggravated by a change in body position, for example, when leaning forward or taking a horizontal position of the body. Pain in the chest and upper abdomen are less common, but cause no less concern for the patient.

Nausea and vomiting are also common symptoms of this disease. An unpleasant smell of rotten food from the mouth, despite regular dental care, as well as belching of food eaten, can also serve as a reason to suspect this disease.

Treatment

Conservative methods of treatment of HHH and GERD are extremely ineffective at the present stage. Drugs are used that reduce the acidity of gastric juice and thereby reduce aggression on the esophageal mucosa. This method has two drawbacks – firstly, by lowering normal acidity, we disrupt food digestion, and secondly, as soon as the drug is stopped, everything returns to its original level, since the cause of the disease has not been eliminated.

Due to the fact that the cause of the disease is a mechanical violation of the integrity of the esophageal opening of the diaphragm, and, as a consequence of the leakage of gastric juice into the esophagus, the reflux can only be eliminated surgically, restoring the integrity of the esophageal opening of the diaphragm and recreating the mechanism that prevents acid from entering the esophagus.Surgical treatment is the only effective method of treatment all over the world. The Nissen operation, in its various modifications, is recognized as the most effective.

During the operation, the dilated esophageal opening is restored by suturing the legs of the diaphragm behind the esophagus (posterior cruraphy). Then the closure mechanism is reconstructed by passing the fundus of the stomach behind the esophagus and stitching the formed cuff with the anterior wall of the stomach. This creates a mechanism that resembles a sippy inkwell.Food can freely enter from the esophagus into the stomach, but cannot flow back out.

Surgery for hernia of the esophageal opening of the diaphragm can be performed both from an open wide access, in which an incision of 30-50 cm along the midline is performed, and laparoscopically, through several punctures of the anterior abdominal wall using endovideosurgical techniques and special instruments.

The capabilities of endovideo equipment allow you to thoroughly examine the entire abdominal cavity, even its remote areas, and modern electrosurgical, ultrasound and laser technology in the hands of an experienced surgeon allows you to carefully and gently carry out all stages of the operation for a hernia of any size.

Relevance

A hiatal hernia is the movement of the lower esophagus, part of the stomach, and sometimes intestinal loops into the chest cavity through the enlarged esophageal opening of the diaphragm.

HHOD is a fairly common disease, according to a number of authors, occupying the fourth place in the structure of diseases of the gastrointestinal tract after peptic ulcer, appendicitis and cholecystitis.

According to statistics, hernia of the esophageal opening of the diaphragm occurs in 5 – 18% of patients examined by X-ray and fibrogastroscopy in connection with diseases of the gastrointestinal tract.They are found mainly in people over 50 and are 10 times more common in women.

The most common symptoms of this disease are

• heartburn, aggravated by bending forward and taking a horizontal position after eating
• less often – the presence of chest pain
• nausea
• Bad breath of rotten food or belching of food eaten

Reasons

In most cases, the cause of a hernia can be a weakening of the ligamentous apparatus of the stomach.It is present in 40% of the population over the age of 45, due to age-related weakening of the ligamentous apparatus.

Another reason may be a significant increase in intra-abdominal pressure due to severe physical exertion, chronic bloating of the intestines, trauma, frequent severe cough (for example, in patients with chronic obstructive bronchitis).

When the stomach moves from the abdominal cavity to the thoracic cavity, the locking mechanism located at the border of the stomach and the esophagus is disturbed, which leads to the throwing of the acidic contents of the stomach into the esophagus, the mucous membrane of which is not adapted to acid.As a result, inflammation of the lower third of the esophagus develops – reflux esophagitis.

Hazards

First of all, with HHH and GERD, the patient’s quality of life is disturbed, which is forced, depending on the symptoms prevailing in him, to change the quantity and quality of food intake. Due to the reflux of gastric juice into the esophagus, its inflammation develops, erosions and ulcers are formed, which is fraught with bleeding , stenosis and development (against the background of chronic chemical aggression on the mucous membrane unadapted to this) esophageal cancer.

In rare cases, an infringement of the stomach or intestines in a hernia can form, which in the absence of timely treatment can lead to necrosis (death) of the restrained organ, severe inflammation of the adipose tissue of the mediastinum, sepsis and death.

Advantages of the operation with us

Our clinic has accumulated vast experience in the treatment of various forms of gastroesophageal reflux and hiatal hernia.

The operation is performed by surgeons with extensive work experience and experience in performing similar laparoscopic operations – more than 200 interventions for hiatal hernia over the past five years.This is a large indicator for such a rare pathology.

Interventions are performed on modern laparoscopic equipment using the latest anesthesia and respiratory equipment and patient monitoring monitors. For plastic surgery, we use mesh implants only from high-quality materials from well-known world manufacturers.

You can get advice free of charge in the surgical department of the Rostov Clinical Hospital of the FGBUZ UOMTs.

Postoperative period

Hospitalization for uncomplicated hiatal hernia is usually 1-3 days, patients can get up and walk on the day of surgery.After laparoscopic surgery, the patient recovers as soon as possible and can return to normal activities and work.

Cost of treatment

• The cost of treatment of a hiatal hernia, taking into account the stay, nutrition, anesthesia and medications, in total is
  from 35,000 rubles.

The cost of the operation may be influenced by the degree of neglect of the disease, concomitant pathology and the method of surgery.

Erosion of the esophagus – Symptoms, treatment

Erosion of the esophagus – a disease characterized by the appearance of defects on the mucous membrane of the esophagus.Inflammation usually complicates the hiatal hernia.

Very often this pathology goes unnoticed, as it has erased symptoms. Many people with this pathology are not even aware of its presence, attributing attacks of mild ailment to errors in nutrition.

Consult a gastroenterologist

Do not postpone treatment

Causes of erosion of the esophagus

The development of pathology can be caused by:

• increased intra-abdominal pressure
• weakening of the muscle tone of the esophagus
• shortening of the length of the esophagus due to tumor or inflammation
• liver disease

• change in the diameter of the esophageal opening
• osteochondrosis (kyphosis) of the spine
• old age

The diseases listed above can provoke a hernia of the esophagus.And they, in turn, are capable of causing the development of mucosal erosion.

How does esophageal erosion manifest itself

The disease may not manifest itself in any way or have blurred symptoms. However, if patients go to a doctor, they most often complain about the appearance of pain behind the sternum or in the abdomen, radiating to different parts of the body. Pain syndrome is similar to the manifestation of angina pectoris.

Often, patients note the appearance of pain while eating or when changing the position of the body.These sensations are accompanied by a feeling of fullness and distention of the stomach. When a person changes position of the body, the manifestation of the symptom decreases.

The following conditions can also be attributed to the characteristic symptoms:

• pain when swallowing food 90 135

• frequent belching
• sudden hiccups

• vomiting
• salivation
• bad breath

Diagnosis of esophageal erosion

The doctor collects anamnesis and asks the patient about the symptoms.If a pathology is suspected, an abdominal X-ray is prescribed. It will help detect the root cause of the development of the disease – a hernia or reflux.

In addition, it is recommended to conduct esophagotonokymography and colonoscopy (FKS), laboratory tests of blood and urine. Shown the delivery of feces for occult blood.

Esophageal erosion therapy

When a diagnosis is made, pills are prescribed to treat the disease. The action of the drugs is aimed at relieving inflammation, reducing the likelihood of contact of the esophagus with hydrochloric acid during reflux, and improving the ability of the intestines to cleanse.

To achieve a positive effect, it is worth taking medications strictly according to the scheme prescribed by the doctor. Several courses may be required to completely cure esophageal erosion. Next, you need to assign a preventive scheme.

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Why Choose American Medical Clinic?

• A team of professionals. Candidates and doctors of medical sciences, professors and associate professors of departments of leading universities, doctors of the first and highest qualification categories work in the clinic 24 hours a day, 7 days a week. We work without holidays and days off to keep you healthy and happy.
• Regular professional development. Each doctor regularly undergoes refresher courses, attends seminars, goes on internships, participates in conferences, and is trained abroad.This helps to maintain the qualifications of doctors at the highest level. Today, AMK doctors’ training allows them to train young doctors, acting as experts at European-level seminars.
• Advanced technologies. We regularly invest not only in training and professional development of personnel, but also in the acquisition of the most modern equipment from leading European manufacturers.
• The value of time. The American Medical Clinic has all the conditions for a comfortable comprehensive examination and diagnosis of a patient on the day of treatment.
• Customer confidence. For 25 years of impeccable work, more than 500,000 patients have entrusted their health to us. More than 80% of patients recommend us to their family and friends.
• Warranties. We are 100% responsible for the quality of the services provided, the high level of which is confirmed by many years of experience.The attention and sensitive attitude of doctors with more than ten years of experience in medical practice give a stable positive result.

See also:

90,000 Gastroesophageal reflux disease – causes, symptoms and diagnosis

Very often the patient does not go to the doctor for an appointment with problems such as headache, cough, runny nose, laryngitis and heartburn. It would seem that a cough can be a cold, a runny nose can be temporarily allergic, the voice can be disrupted.What about heartburn? Well, who doesn’t have this heartburn? This is with our that food, rhythm of life, employment.

The above complaints do not always mean colds, allergies and angina pectoris. This clinical picture can occur with gastroesophageal reflux disease (GERD).

GERD is an acid-dependent disease that occurs due to the throwing of acidic stomach contents into the esophagus, which causes heartburn, belching with air, sour belching, as well as nausea, a feeling of an increased amount of fluid in the mouth, pain in the epigastric region, sleep disturbance associated with pain or heartburn, discomfort when swallowing.

GERD can be promoted by increased intra-abdominal pressure, impaired motor activity of the esophagus and stomach. Often overweight people, food lovers, especially in the late evening and at night, smokers, alcohol drinkers, avid coffee lovers, people suffering from prolonged constipation are susceptible to reflux. One of the provocateurs is the improvement of well-being: a person eats more and moves a little.

GERD is an insidious disease. Even bronchial asthma can be not a pulmonary disease, but a manifestation of reflux!

Why is GERD misdiagnosed?

For example, a patient begins to use drugs intended for asthmatics – they are aimed at facilitating breathing, expanding the bronchi.Starting to take them with a patient with inflammation of the esophagus does not get rid of the problem, the drugs do not help. Meanwhile, the inflamed walls of the esophagus begin to collapse, taking on the risk of erosion, bleeding, up to oncology.

A dry, persistent cough, complaints of frequent heartburn, sour belching, bloating, constipation, nausea, a feeling of quick satiety when eating, heaviness in the stomach should alert the doctor and the patient.

Sudden angina pectoris or pain in the heart, as well as in the epigastric region, should not be ignored, especially if these sensations arise immediately after eating.

Pain in the region of the heart or “pseudo-coronary” pain often occurs with inflammatory changes in the wall of the esophagus. Pain in GERD can cause a spasm of the coronary arteries, thereby provoking an attack of angina pectoris. There is even a saying: “If your patient is less than thirty-five years old and does not have heart defects, look for the cause in the stomach”

A common manifestation of GERD is a white coating on the tongue, bad breath, damage to the gums, damage to the tooth enamel. Again, you can endlessly treat the symptoms at the dentist, without reaching the cause, lose all your teeth and never get rid of the problem.Because it lies deeper. And you need to stop it there.

If GERD is not treated in time, it can cause complications such as pneumonia, diseases of the pharynx, larynx, vocal cords, esophageal oncology. Therefore, it is absolutely recommended to exclude the ill-fated reflux in ENT diseases and bronchopulmonary diseases.

In order for the patient to be correctly diagnosed with GERD, it is necessary to consult a gastroenterologist who will prescribe additional examination methods to the patient.

Diagnosis of gastroesophageal reflux disease is carried out using pH -metry, endoscopic examination of the mucous membrane, and, if necessary, biopsy and chromoscopy. X-ray examination is easy to identify a hiatal hernia, if any.

To reduce acidity in modern medicine, various groups of drugs are used: antisecretory agents (H2-blockers, M-anticholinergics, proton pump inhibitors), antacids.

Given the dominance of TV commercials, a patient with heartburn begins to self-medicate. However, only a doctor should prescribe modern and correct treatment, which will reduce the duration of treatment and the cost of it, and will also help to avoid formidable complications.

It is important to remember that in addition to miraculous pharmacological agents, the patient will have to reconsider his lifestyle: quit smoking, stop drinking alcohol, change the diet, do not go to bed after eating, etc.and also consult a doctor in time.

The following article will focus on lifestyle and dietary advice for GERD.

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