What is a hiatal hernia and how does it affect your body. What are the common symptoms of a hiatal hernia. How is a hiatal hernia diagnosed and treated. What lifestyle changes can help manage hiatal hernia symptoms.

Understanding Hiatal Hernias: Types and Mechanisms

A hiatal hernia occurs when the stomach pushes through an opening in the diaphragm called the hiatus. This condition can be classified into two main types:

1. Sliding hiatal hernia: The most common type, where the stomach and lower part of the esophagus slide up into the chest cavity.
2. Paraesophageal hernia: A less common but potentially more serious type, where part of the stomach squeezes through the hiatus next to the esophagus.

While sliding hernias are generally less concerning, paraesophageal hernias can lead to complications such as strangulation, where the blood supply to the stomach becomes compromised.

Recognizing Hiatal Hernia Symptoms

Many individuals with hiatal hernias may not experience any noticeable symptoms. However, when symptoms do occur, they can include:

• Heartburn, often associated with gastroesophageal reflux disease (GERD)
• Chest discomfort or pain
• Bloating and belching
• Difficulty swallowing
• Regurgitation of food or liquids
• A sour taste in the mouth
• Shortness of breath

Are certain symptoms more serious than others? Yes, severe chest or abdominal pain, persistent nausea, vomiting, and inability to have a bowel movement or pass gas can indicate a medical emergency and require immediate attention.

Unraveling the Causes of Hiatal Hernias

The exact cause of hiatal hernias remains unclear in many cases. However, several factors may contribute to their development:

• Congenital defects resulting in a larger-than-normal hiatal opening
• Trauma or injury to the diaphragm area
• Age-related changes in diaphragm tissue
• Increased abdominal pressure due to pregnancy, obesity, or chronic coughing
• Straining during bowel movements or heavy lifting

Can lifestyle factors influence the development of hiatal hernias? While not direct causes, certain habits like smoking, poor posture, and consuming large meals may exacerbate symptoms or increase the risk of developing a hiatal hernia.

Identifying Risk Factors for Hiatal Hernias

Several factors can increase an individual’s likelihood of developing a hiatal hernia:

• Age: People over 50 are more susceptible
• Gender: Women tend to be affected more often than men
• Body weight: Obesity is a significant risk factor
• Pregnancy: The increased abdominal pressure can contribute to hernia formation
• Genetic predisposition: Some individuals may inherit a tendency towards hiatal hernias

How can understanding these risk factors help in prevention? While some factors like age and genetics are beyond control, maintaining a healthy weight and avoiding excessive strain on the abdominal area can potentially reduce the risk of developing a hiatal hernia.

Diagnostic Approaches for Hiatal Hernias

Diagnosing a hiatal hernia typically involves a combination of medical history assessment and specific diagnostic tests:

1. Barium swallow: A contrast-enhanced X-ray that provides a clear view of the esophagus and stomach.
2. Endoscopy: A procedure using a flexible tube with a camera to visualize the upper digestive tract.
3. Esophageal manometry: A test to measure pressure within the esophagus during swallowing.
4. pH testing: Measures acid levels in the esophagus to assess for reflux.
5. Blood tests: May be conducted to check for anemia if bleeding is suspected.

What makes these diagnostic methods effective? Each test provides unique insights into the structure and function of the upper digestive system, allowing for accurate diagnosis and appropriate treatment planning.

Importance of Early Detection

Early diagnosis of hiatal hernias, especially paraesophageal hernias, is crucial for preventing potential complications. Regular check-ups and prompt reporting of persistent digestive symptoms to a healthcare provider can facilitate timely intervention.

Treatment Options for Hiatal Hernias

The treatment approach for hiatal hernias varies depending on the type, severity, and associated symptoms:

Non-Surgical Management

For many individuals with hiatal hernias, especially those with mild symptoms or sliding hernias, non-surgical treatments may be sufficient:

• Medications: Including antacids, proton pump inhibitors, and H-2 receptor blockers to manage acid reflux symptoms.
• Prokinetics: Drugs that strengthen the lower esophageal sphincter and improve stomach emptying.
• Lifestyle modifications: Dietary changes, weight loss, and positional adjustments can often provide significant relief.

Surgical Interventions

Surgery may be recommended in certain cases, particularly for paraesophageal hernias or when conservative treatments fail:

• Laparoscopic repair: A minimally invasive procedure to reinforce the hiatus and reposition the stomach.
• Open surgery: Traditional surgical approach for complex cases or when laparoscopy is not suitable.

What factors determine the need for surgical intervention? The size of the hernia, severity of symptoms, risk of complications, and overall health of the patient all play a role in deciding whether surgery is necessary.

Lifestyle Modifications and Home Remedies for Hiatal Hernias

Implementing certain lifestyle changes can significantly improve symptoms and quality of life for individuals with hiatal hernias:

Dietary Adjustments

• Consume smaller, more frequent meals to reduce pressure on the stomach
• Avoid acidic foods, fatty foods, and known trigger foods
• Limit alcohol, caffeine, and carbonated beverages
• Opt for a soft diet for several weeks following surgical repair

Positional Changes

• Elevate the head of the bed by 6 inches to reduce nighttime reflux
• Avoid lying down for 3-4 hours after meals
• Practice good posture to reduce abdominal pressure

Weight Management

Maintaining a healthy weight can alleviate symptoms and reduce the risk of hernia progression. How does weight loss help? It decreases abdominal pressure, potentially reducing the likelihood of stomach protrusion through the hiatus.

Stress Reduction

Implementing stress management techniques such as meditation, yoga, or deep breathing exercises can help reduce symptoms exacerbated by stress.

Complications and Long-Term Outlook for Hiatal Hernias

While many hiatal hernias remain asymptomatic or manageable with conservative treatments, potential complications can arise, especially with untreated paraesophageal hernias:

• Strangulation: A medical emergency where blood supply to the herniated portion of the stomach is cut off
• Bleeding: Chronic irritation can lead to ulceration and bleeding
• Obstruction: Food passage can become blocked, causing severe discomfort and potential complications
• Chronic GERD: Ongoing acid reflux can lead to esophageal damage and increase the risk of Barrett’s esophagus

What is the prognosis for individuals with hiatal hernias? With proper management and timely intervention when necessary, most people with hiatal hernias can lead normal, symptom-free lives. Regular follow-ups with healthcare providers are essential for monitoring the condition and adjusting treatment plans as needed.

Prevention Strategies

While not all hiatal hernias can be prevented, certain measures may reduce the risk or prevent symptom exacerbation:

• Maintain a healthy body weight
• Practice proper lifting techniques to avoid abdominal strain
• Quit smoking to reduce pressure on the lower esophageal sphincter
• Manage chronic conditions that increase abdominal pressure, such as chronic cough

By understanding the nature of hiatal hernias, recognizing symptoms, and implementing appropriate lifestyle modifications, individuals can effectively manage this condition and minimize its impact on daily life. Regular communication with healthcare providers ensures optimal management and timely intervention when necessary, promoting long-term digestive health and overall well-being.

Symptoms, Causes, Diagnosis, and Treatment

Written by WebMD Editorial Contributors

• What Is a Hiatal Hernia?
• Hiatal Hernia Symptoms
• Hiatal Hernia Causes
• Hiatal Hernia Risk Factors
• Hiatal Hernia Diagnosis
• Hiatal Hernia Treatment
• Hiatal Hernia Lifestyle Changes and Home Remedies
• More

A hiatal hernia is when your stomach bulges up into your chest through an opening in your diaphragm, the muscle that separates the two areas. The opening is called the hiatus, so this condition is also called a hiatus hernia.

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

Ordinarily, your esophagus (food pipe) goes through the hiatus and attaches to your stomach. In a sliding hiatal hernia, your stomach and the lower part of your esophagus slide up into your chest through the diaphragm. Most people with hiatal hernias have this type.

A paraesophageal hernia is more dangerous. Your esophagus and stomach stay where they should be, but part of your stomach squeezes through the hiatus to sit next to your esophagus. Your stomach can become squeezed and lose its blood supply. Your doctor might call this a strangulated hernia.

Many people with hiatal hernia don’t notice any symptoms. Others may have:

• Heartburn from gastroesophageal reflux disease (GERD)
• Chest pain
• Bloating
• Burping
• Trouble swallowing
• Bad taste in your mouth
• An upset stomach and vomiting
• Backflow of food or liquid from your stomach into your mouth
• Shortness of breath

Get medical care right away if you have a hiatal hernia and:

• Severe pain in your chest or belly
• A persistent upset stomach
• Vomiting
• Can’t poop or pass gas

These could be signs of a strangulated hernia or an obstruction, which are medical emergencies.

Doctors don’t know why most hiatal hernias happen. Causes might include:

• Being born with a larger hiatal opening than usual
• Injury to the area
• Changes in your diaphragm as you age
• A rise in pressure in your belly, as from pregnancy, obesity, coughing, lifting something heavy, or straining on the toilet

Hiatal hernias happen more often in women, people who are overweight, and people older than 50.

To diagnose a hiatal hernia, your doctor may do tests including:

• Barium swallow. You drink a liquid that shows up on an X-ray so your doctor can get a better look at your esophagus and stomach.
• Endoscopy. Your doctor puts a long, thin tube called an endoscope down your throat. A camera on the end shows inside your esophagus and stomach.
• Esophageal manometry (pressure study). A different kind of tube goes down your throat to check the pressure in your esophagus when you swallow.
• pH test. This measures the acid levels in your esophagus.

If anemia is a concern, your doctor may take a blood sample to check your red blood cell count.

Most people don’t notice symptoms of a hiatal hernia and don’t need treatment.

If you have acid reflux, your doctor may suggest medications to treat those symptoms, including:

• Antacids to weaken your stomach acid
• Proton pump inhibitors or H-2 receptor blockers to keep your stomach from making as much acid
• Prokinetics to make your esophageal sphincter — the muscle that keeps stomach acid from backing up into your esophagus — stronger. They also help muscles in your esophagus work and help your stomach empty.

Your doctor might do surgery if you have a paraesophageal hernia (when part of your stomach squeezes through the hiatus) so your stomach doesn’t become strangled. You may also need surgery if sliding hernias bleed or become large, strangulated, or inflamed.

In surgery, your doctor reinforces your hiatus and moves your stomach. Many hiatal hernia surgeries use a method called laparoscopy. Your doctor will make a few small (5 to 10 millimeter) cuts in your belly. They insert a tool called a laparoscope through these incisions, and it sends pictures to a monitor so your doctor can see inside your body. These “minimally invasive” procedures have smaller cuts, less risk of infection, less pain and scarring, and faster recovery than traditional surgeries. You can probably go back to regular activity in 2 weeks.

Some changes to your daily life can help with acid reflux symptoms. They include:

• Don’t exercise or lie down for 3 or 4 hours after you eat.
• Avoid acidic foods like orange juice, tomato sauce, and soda.
• A diet of mashed and soft foods is recommended for up to 2-3 weeks after surgery.
• Limit fried and fatty foods, alcohol, vinegar, chocolate, and caffeine.
• Eat smaller meals (four or five small meals each day) and eat slowly.
• Lift the head of your bed about 6 inches.
• Don’t wear tight belts or clothes that put pressure on your belly.
• Lose extra pounds.
• Don’t smoke. Smoking is an intense heartburn generator.

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Symptoms, Causes, Diagnosis, and Treatment

Written by WebMD Editorial Contributors

• What Is a Hiatal Hernia?
• Hiatal Hernia Symptoms
• Hiatal Hernia Causes
• Hiatal Hernia Risk Factors
• Hiatal Hernia Diagnosis
• Hiatal Hernia Treatment
• Hiatal Hernia Lifestyle Changes and Home Remedies
• More

A hiatal hernia is when your stomach bulges up into your chest through an opening in your diaphragm, the muscle that separates the two areas. The opening is called the hiatus, so this condition is also called a hiatus hernia.

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

Ordinarily, your esophagus (food pipe) goes through the hiatus and attaches to your stomach. In a sliding hiatal hernia, your stomach and the lower part of your esophagus slide up into your chest through the diaphragm. Most people with hiatal hernias have this type.

A paraesophageal hernia is more dangerous. Your esophagus and stomach stay where they should be, but part of your stomach squeezes through the hiatus to sit next to your esophagus. Your stomach can become squeezed and lose its blood supply. Your doctor might call this a strangulated hernia.

Many people with hiatal hernia don’t notice any symptoms. Others may have:

• Heartburn from gastroesophageal reflux disease (GERD)
• Chest pain
• Bloating
• Burping
• Trouble swallowing
• Bad taste in your mouth
• An upset stomach and vomiting
• Backflow of food or liquid from your stomach into your mouth
• Shortness of breath

Get medical care right away if you have a hiatal hernia and:

• Severe pain in your chest or belly
• A persistent upset stomach
• Vomiting
• Can’t poop or pass gas

These could be signs of a strangulated hernia or an obstruction, which are medical emergencies.

Doctors don’t know why most hiatal hernias happen. Causes might include:

• Being born with a larger hiatal opening than usual
• Injury to the area
• Changes in your diaphragm as you age
• A rise in pressure in your belly, as from pregnancy, obesity, coughing, lifting something heavy, or straining on the toilet

Hiatal hernias happen more often in women, people who are overweight, and people older than 50.

To diagnose a hiatal hernia, your doctor may do tests including:

• Barium swallow. You drink a liquid that shows up on an X-ray so your doctor can get a better look at your esophagus and stomach.
• Endoscopy. Your doctor puts a long, thin tube called an endoscope down your throat. A camera on the end shows inside your esophagus and stomach.
• Esophageal manometry (pressure study). A different kind of tube goes down your throat to check the pressure in your esophagus when you swallow.
• pH test. This measures the acid levels in your esophagus.

If anemia is a concern, your doctor may take a blood sample to check your red blood cell count.

Most people don’t notice symptoms of a hiatal hernia and don’t need treatment.

If you have acid reflux, your doctor may suggest medications to treat those symptoms, including:

• Antacids to weaken your stomach acid
• Proton pump inhibitors or H-2 receptor blockers to keep your stomach from making as much acid
• Prokinetics to make your esophageal sphincter — the muscle that keeps stomach acid from backing up into your esophagus — stronger. They also help muscles in your esophagus work and help your stomach empty.

Your doctor might do surgery if you have a paraesophageal hernia (when part of your stomach squeezes through the hiatus) so your stomach doesn’t become strangled. You may also need surgery if sliding hernias bleed or become large, strangulated, or inflamed.

In surgery, your doctor reinforces your hiatus and moves your stomach. Many hiatal hernia surgeries use a method called laparoscopy. Your doctor will make a few small (5 to 10 millimeter) cuts in your belly. They insert a tool called a laparoscope through these incisions, and it sends pictures to a monitor so your doctor can see inside your body. These “minimally invasive” procedures have smaller cuts, less risk of infection, less pain and scarring, and faster recovery than traditional surgeries. You can probably go back to regular activity in 2 weeks.

Some changes to your daily life can help with acid reflux symptoms. They include:

• Don’t exercise or lie down for 3 or 4 hours after you eat.
• Avoid acidic foods like orange juice, tomato sauce, and soda.
• A diet of mashed and soft foods is recommended for up to 2-3 weeks after surgery.
• Limit fried and fatty foods, alcohol, vinegar, chocolate, and caffeine.
• Eat smaller meals (four or five small meals each day) and eat slowly.
• Lift the head of your bed about 6 inches.
• Don’t wear tight belts or clothes that put pressure on your belly.
• Lose extra pounds.
• Don’t smoke. Smoking is an intense heartburn generator.

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Gastroesophageal reflux disease (GERD). Hernia of the esophageal opening of the diaphragm (HH). | Center for Endosurgical Technologies

Gastroesophageal reflux disease (GERD) is a disease characterized by the reflux of gastric contents into the esophagus.

Hiatal hernia is an enlargement of the hiatus that allows part of the stomach to enter the chest. In 90% hiatal hernia leads to GERD.

40% of people constantly (with varying frequency) experience heartburn, the main symptom of GERD. In general, the prevalence of GERD in Russia among the adult population is 40-60%, and esophagitis is found in 45-80% of people with GERD.

Causes of GERD.

The human stomach contains hydrochloric acid, the walls of the stomach are resistant to acid. The esophagus does not have such stability. The body has a number of mechanisms that prevent the entry of gastric contents into the esophagus. For various reasons, these mechanisms may not be able to cope, and gastric contents enter the esophagus, burning its walls.

D The main symptom of GERD is heartburn,

occurs in 83% of patients. In addition, symptoms of reflux (casting) can be pain in the upper abdomen and behind the sternum, belching, regurgitation of food, and swallowing disorders. GERD can also lead to disruption of the heart and lungs. Symptoms may be aggravated by violation, alcohol intake, physical activity, bending over and in a horizontal position.

Diagnosis of GERD is based on characteristic complaints. The main method of instrumental diagnosis of GERD is FGS. If necessary, X-ray examination with contrast is performed.

Treatment of GERD must be prescribed by a physician.

This usually includes diet and proton pump inhibitors (omeprazole, pariet). The main treatment should be carried out within 4-8 weeks, maintenance therapy – 6-12 months. In this case, the probability of relapse (return of the disease) is up to 80% with erosive esophagitis and up to 98% with improperly prescribed treatment.

In addition, it is necessary: ​​

• Reduce body weight (if it is increased), stop smoking;
• Diet: Avoid tomatoes in any form, acidic fruit juices, gas-producing foods, fats, chocolate, coffee, garlic, onions, peppers, alcohol, very spicy, hot or cold foods, and carbonated drinks;
• Overeating should be avoided; they should stop eating two hours before bedtime. You should not increase the number of meals: it is necessary to observe 3-4 meals a day without snacks;
• Conditions that increase intra-abdominal pressure should be prevented (exclusion of loads that increase intra-abdominal pressure, wearing corsets, bandages and tight belts, lifting weights of more than 8-10 kg on both arms, work associated with forward bending of the body, physical exercises associated with muscle strain abdominals)

In some cases, an operation is prescribed.

Surgery is necessary if:

• Therapy fails for 3 months or more (reflux persists or pain or heartburn persists)
• Presence of heart attacks (angina pectoris, arrhythmias) caused by GERD
• Organic damage to the esophagus (scarring, stenosis)
• Barrett’s esophagus according to FGS

CAUTION. Barrett’s esophagus is one possible complication of GERD. Barrett’s esophagus is 125 times more likely to develop esophageal cancer than the general population!!! Esophageal cancer is very aggressive and responsive to therapy.

Laparoscopic fundoplication is the gold standard for GERD surgery worldwide.

In this operation, the fundus of the stomach is wrapped around the esophagus and sutured. The created cuff prevents the reflux of gastric contents into the esophagus.

We have been performing fundoplication since 2001. During this time, more than 300 operations have been performed. In 15 years, we have never needed to switch to open surgery. The presence of previous operations is not a contraindication to surgery.

The operation is very well tolerated by the patient. After our operations, the patient stays in the hospital for 1 day (on average). Most patients are discharged the next day. Pain is minimal.

We perform the operation with a laparoscopic (endovideosurgical) approach. With this technique, there is no large incision. 5 punctures of the anterior abdominal wall are performed (5 and 10 mm each). An inert gas is pumped inside, a video camera and instruments are introduced. The operation is carried out from the inside.

After the operation, you must follow a diet and limit physical activity for a month. A month later, the restrictions are lifted.

To make an appointment: e-mail: [email protected], phone: +7 (391) 297-52-52

Dietary recommendations for HH

The abbreviation HH stands for hiatal hernia. This is a fairly common pathology, which mainly occurs at an older age. Unlike hernias of other localization, the treatment of this disease can be carried out by conservative methods, the most basic of which is the implementation of special dietary recommendations.

Causes and manifestations of HH

HH is a sac-like protrusion of the esophagus or part of the stomach in the esophageal region of the diaphragm, which is the muscular septum between the chest and abdominal cavity. The development of such a protrusion is a consequence of a decrease in the tone of the muscles of the diaphragm, as well as the expansion of its esophageal opening. There are several etiological (causal) factors that contribute to the formation of a hernia, these include:

• Increased intrathoracic pressure due to systematic hard physical work, prolonged coughing, pregnancy, childbirth in women, chronic constipation.
• Congenital decrease in elasticity, strength of muscle fibers and connective tissue of the diaphragm.
• Violation of muscle innervation with a subsequent decrease in their tone.
• Malnutrition, especially associated with overeating at night, abuse of alcoholic beverages, fried, fatty foods.

The impact of such etiological factors is cumulative, so HH develops predominantly in older people.

Hernia of the esophageal opening of the diaphragm for a long time may not manifest itself in any way. As the protrusion increases, there is pain behind the sternum or epigastrium (upper abdomen, stomach projection area), almost constant heartburn, worsening of swallowing. For accurate detection of a hernia, additional instrumental techniques for its visualization are used – ultrasound, x-ray of the esophagus with a contrast agent.

Diet for HH

Fulfillment of dietary recommendations for hiatal hernia is the main measure of its conservative treatment. The main goal of the diet is to reduce the load on the digestive system, reduce gas formation in the intestines, as well as normalize stools and prevent constipation, which contribute to increased intra-abdominal pressure. Therefore, the recommendations include the following products:

• Low-fat fermented milk products – yogurt, kefir.
• Non-fatty meats – rabbit, chicken, beef.
• Cereals in the form of porridge – buckwheat, rice, millet.
• Fresh vegetables.

Fatty meat (pork, duck), coarse vegetable fiber (cabbage) and legumes (peas, beans), fatty milk, spices and marinades are excluded. Alcohol and smoking are also prohibited. A certain similarity has a diet for stomach ulcers. HH is characterized by the reflux of gastric juice into the esophagus, so the recommendations are aimed at reducing its acidity.