What are the types of hiatal hernias. How do hiatal hernias cause chest and back pain. When is surgical repair necessary for hiatal hernias. What are the treatment options for hiatal hernia-related discomfort.

Understanding Hiatal Hernias: Types and Prevalence

A hiatal hernia occurs when part of the stomach pushes through the hiatus, an opening in the diaphragm that separates the chest cavity from the abdomen. There are two main types of hiatal hernias:

• Sliding hiatal hernia
• Paraesophageal hernia

Sliding hiatal hernias are the most common, affecting over 25% of adults by age 40. In this type, the stomach and lower esophagus slide up into the chest through the hiatus. Paraesophageal hernias are less common but potentially more serious, as they can lead to complications if left untreated.

Prevalence of Hiatal Hernias

Do hiatal hernias become more common with age? Indeed, the prevalence of hiatal hernias increases as people get older. By age 40, more than 1 in 4 adults have a sliding hiatal hernia. This high prevalence underscores the importance of understanding the condition and its potential impact on overall health.

Symptoms and Complications of Hiatal Hernias

While many hiatal hernias are asymptomatic, they can cause a range of symptoms and complications, particularly in the case of paraesophageal hernias. Common symptoms include:

• Chest pain
• Epigastric pain (upper abdominal discomfort)
• Difficulty swallowing (dysphagia)
• Shortness of breath
• Early satiety or feeling full quickly
• Gastroesophageal reflux disease (GERD) symptoms

Can a hiatal hernia cause back pain? While not a common symptom, a large paraesophageal hernia could potentially cause back pain. However, chest and upper abdominal pain are more typical, especially during or after eating.

Potential Complications

What are the risks of leaving a paraesophageal hernia untreated? Symptomatic paraesophageal hernias can lead to serious complications if left untreated, including:

• Incarceration: The stomach becomes stuck, resulting in obstruction
• Ischemia: Blood supply to the stomach is cut off
• Cameron’s erosions: Stomach ulcers that can cause chronic blood loss and anemia

These complications may necessitate emergency surgery, highlighting the importance of proper diagnosis and timely treatment.

Diagnosis and Evaluation of Hiatal Hernias

Accurate diagnosis of hiatal hernias is crucial for determining the appropriate treatment approach. Diagnostic methods may include:

• Barium swallow test
• Upper endoscopy
• CT scan
• Manometry

How is a hiatal hernia differentiated from other conditions? Given that chest pain can have multiple causes, it’s essential to rule out cardiac issues, especially in patients with large paraesophageal hernias. A comprehensive evaluation, including cardiac tests, may be necessary to ensure accurate diagnosis and appropriate treatment planning.

Assessing Symptom Severity

Do all hiatal hernias require treatment? Not necessarily. Many sliding hiatal hernias and asymptomatic paraesophageal hernias can be safely monitored without immediate intervention. However, when symptoms begin to affect quality of life or pose risks of complications, treatment becomes necessary.

Conservative Management of Hiatal Hernias

For many patients with hiatal hernias, especially those with sliding hernias or mild symptoms, conservative management may be sufficient. This approach typically includes:

• Dietary modifications
• Lifestyle changes (e.g., weight loss, avoiding late-night meals)
• Sleeping with the head elevated
• Medication to reduce stomach acid

How effective are lifestyle changes in managing hiatal hernia symptoms? Many patients find significant relief through these conservative measures. However, if symptoms persist or worsen despite these efforts, more aggressive treatment may be necessary.

Medications for Symptom Relief

What medications are commonly used to manage hiatal hernia symptoms? Acid-reducing medications, such as proton pump inhibitors (PPIs) or H2 blockers, are often prescribed to alleviate symptoms associated with GERD, which frequently accompanies hiatal hernias. These medications can provide relief for many patients, potentially delaying or avoiding the need for surgical intervention.

Surgical Repair of Hiatal Hernias: When Is It Necessary?

While many hiatal hernias can be managed conservatively, surgical repair may be necessary in certain cases. The decision to pursue surgery depends on several factors:

• Type of hernia (sliding vs. paraesophageal)
• Severity of symptoms
• Presence of complications
• Failure of conservative management

When should a sliding hiatal hernia be repaired? Surgical repair of a sliding hiatal hernia is typically considered when:

• GERD symptoms persist despite lifestyle modifications and medications
• Complications such as Barrett’s esophagus develop
• The hernia is large and causing significant discomfort

For paraesophageal hernias, the threshold for surgical intervention is generally lower due to the increased risk of complications. Symptomatic paraesophageal hernias are usually repaired to prevent potential emergencies such as incarceration or ischemia.

Assessing Surgical Candidacy

How do surgeons determine if a patient is a good candidate for hiatal hernia repair? Surgeons consider various factors, including:

• Overall health and fitness for surgery
• Severity and duration of symptoms
• Size and type of hernia
• Presence of other medical conditions
• Patient’s preferences and goals

A thorough preoperative evaluation, including cardiac clearance when necessary, helps ensure that surgery is both safe and appropriate for each individual patient.

Minimally Invasive Surgical Techniques for Hiatal Hernia Repair

Advancements in surgical techniques have made hiatal hernia repair safer and less invasive than ever before. The most common approach is laparoscopic repair, which offers several advantages:

• Smaller incisions
• Reduced postoperative pain
• Shorter hospital stay
• Faster recovery
• Lower risk of complications

How is a laparoscopic hiatal hernia repair performed? The procedure typically involves:

1. Making several small incisions in the abdomen
2. Inserting a camera and specialized instruments
3. Returning the stomach to its proper position below the diaphragm
4. Closing the hiatal defect
5. Reinforcing the repair with mesh in some cases
6. Performing a fundoplication to prevent reflux, if necessary

Most paraesophageal hernias can be successfully repaired using this minimally invasive approach, even in cases of large hernias.

Robotic-Assisted Surgery

What are the benefits of robotic-assisted hiatal hernia repair? Some surgeons utilize robotic-assisted techniques, which offer enhanced visualization and precision. This approach may be particularly beneficial for complex cases or reoperations. However, the choice between laparoscopic and robotic-assisted surgery often depends on surgeon expertise and institutional resources.

Recovery and Outcomes After Hiatal Hernia Surgery

Recovery following hiatal hernia repair varies depending on the individual and the specific surgical approach used. Generally, patients can expect:

• A hospital stay of 1-3 days for uncomplicated cases
• Gradual return to normal activities over 2-4 weeks
• Dietary restrictions in the immediate postoperative period
• Follow-up appointments to monitor healing and symptom resolution

What is the success rate of hiatal hernia repair? The majority of patients experience significant improvement in their symptoms following surgery. Success rates for laparoscopic hiatal hernia repair are generally high, with most studies reporting good to excellent outcomes in 80-90% of patients.

Long-Term Outcomes and Potential Complications

While hiatal hernia repair is generally safe and effective, it’s important to be aware of potential complications and long-term considerations:

• Recurrence of the hernia (occurs in a small percentage of cases)
• Persistent or new-onset dysphagia
• Gas-bloat syndrome
• Inability to belch or vomit (if a tight fundoplication is performed)

How can patients optimize their long-term outcomes after hiatal hernia repair? Following postoperative instructions carefully, maintaining a healthy weight, and avoiding activities that increase abdominal pressure can help ensure the best possible long-term results.

Alternative and Emerging Treatments for Hiatal Hernias

While surgical repair remains the gold standard for treating symptomatic hiatal hernias, especially paraesophageal hernias, researchers continue to explore alternative and less invasive options. Some emerging treatments include:

• Endoscopic plication techniques
• Transoral incisionless fundoplication (TIF)
• Magnetic sphincter augmentation devices

Are these alternative treatments effective for all types of hiatal hernias? Currently, these newer approaches are primarily used for small sliding hiatal hernias associated with GERD. Large paraesophageal hernias still typically require traditional surgical repair due to the risk of complications.

The Role of Clinical Trials

How can patients stay informed about new treatment options for hiatal hernias? Participating in or following the progress of clinical trials can provide insight into emerging therapies. Patients should discuss any interest in experimental treatments with their healthcare providers to determine if they might be suitable candidates for ongoing studies.

In conclusion, hiatal hernias, particularly those causing chest and back pain, require careful evaluation and individualized treatment planning. While many cases can be managed conservatively, surgical repair remains an important option for symptomatic patients or those at risk of complications. Advances in minimally invasive techniques have made surgery safer and more effective than ever before, offering hope for improved quality of life for those affected by this common condition.

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”

Treatment and when to seek help

People with a hiatal hernia can experience heartburn, often after eating. This can cause an individual to experience a painful, burning feeling in their chest. When the hernia is larger, it can also cause pain or pressure in the chest if it affects the heart and lungs.

A hiatal hernia is where the upper part of the stomach, or another internal organ, bulges through the opening in the diaphragm, called the hiatus.

The diaphragm is a thin muscle separating the abdomen and the chest. It helps stop acid from coming up into the esophagus, or food pipe. A hiatal hernia makes it easier for acid to reach the esophagus.

This article looks at what chest pain from a hiatal hernia feels like, whether chest pain signifies that a hernia is worsening, treatment options, and when to contact a doctor.

Hiatal hernia can cause chest pain and has associations with the following conditions.

Gastroesophageal reflux disease (GERD) and heartburn

In many cases, chest pain from a hiatal hernia has links to acid and the contents of the stomach traveling up to the esophagus.

This is called gastroesophageal reflux disease (GERD) and can cause a person to experience heartburn. Heartburn feels like a burning sensation in the middle of the chest and can cause a foul, acidic taste in the mouth.

According to a 2019 article, the chest pain related to GERD can feel similar to the pain associated with a heart attack. The pain can also occur without heartburn.

Additionally, GERD can cause the muscles in the esophagus to spasm. This can also cause a person to experience chest pain that they could mistake for a heart attack.

Heart and respiratory system

Hiatal hernias can affect the respiratory system, which may also cause pain or pressure in the chest.

As the hernia enlarges and takes up more space, it can compress the arteries in the heart and lungs. This may cause a part of the lung to collapse, which can lead to the following:

• trouble breathing
• an intense tightness in the chest
• shortness of breath

Hiatal hernias may also cause pressure on the heart, called tamponade. The hernia can compress the heart, causing shortness of breath and chest discomfort.

Chest pain can signify a strangulated or worsening hiatal hernia.

A hernia becomes strangled when the blood supply to the hernia is cut off.

A doctor may suspect that a hiatal hernia is strangulated if a person has severe chest or upper abdominal pain, usually after a meal. In this scenario, individuals may also experience retching and vomiting.

If people suspect their hernia is worsening, they should contact a doctor.

Depending on the severity of a hiatal hernia, a person may not require medical treatment.

A 2022 article notes that while hiatal hernias are common and affect up to 60% of individuals over 50 years of age, only 9% experience symptoms. People who do not experience symptoms do not require medical treatment.

Home treatment and management

The following can help manage the symptoms of a hiatal hernia:

• stopping smoking, if applicable
• eating small meals
• avoiding oily or fried foods
• avoiding caffeine
• avoiding alcohol
• maintaining a moderate weight
• taking over-the-counter (OTC) antacids
• being upright while eating
• eating at least 3 hours before going to bed

Medical treatment

If a person experiences symptoms of a hiatal hernia, such as GERD, they may require medical treatment.

This may involve using proton pump inhibitors, which are medications to treat heartburn, acid reflux, GERD, and stomach ulcers. Doctors may also recommend surgical procedures.

Procedures and surgeries include:

• Transoral incisionless fundoplication: This procedure does not involve incisions. A doctor places an endoscope down the throat and into the esophagus to tighten it. They then wrap parts of the stomach — the cardia and the fundus — around the esophagus.
• Endoluminal fundoplication: A doctor places an endoscope, a tube that attaches to a camera and light, down the throat. They then tighten the area where the esophagus joins the stomach to prevent acid from flowing into the esophagus.
• Endoscopic anterior fundoplication with the Medigus Ultrasonic Surgical Endostapler: A doctor uses surgical staples to attach the fundus to the esophagus. This procedure stops acid reflux.
• Nissen fundoplication: Surgeons can perform this procedure laparoscopically, which means through tiny incisions. They insert a laparoscope, a tube with a camera and light attached, to repair the hernia and tighten the stomach opening.
• Open surgery: This involves the surgeon making a larger incision into the abdomen. The surgeon pulls the stomach up into the abdominal cavity and wraps the fundus around the lower part of the food pipe. This prevents acid from leaking up into the esophagus.

Someone should contact a doctor if they experience chest pain, whether they believe it is due to a hiatal hernia. Chest pain may indicate a serious medical condition, such as a heart attack.

Individuals should also contact a doctor if their symptoms:

• persist for longer than 3 weeks
• do not resolve from using OTC antacids
• worsen

A hiatal hernia can cause a person to experience chest pain. One of the most common presentations of a hiatal hernia is GERD. GERD can cause a person to experience heartburn, causing discomfort and pain in the chest.

It can also cause the esophageal muscles to spasm, resulting in chest pain that feels similar to chest pain relating to a heart attack.

Other causes of chest pain from a hiatal hernia are pressure on the lungs or chest due to the expansion of the hernia. These may cause shortness of breath and chest discomfort.

Severe chest pain, along with some other symptoms such as retching and fever, may indicate that a hiatal hernia is strangulated.

This is a medical emergency, and anyone with these symptoms should seek immediate emergency medical assistance.

People should also seek medical attention immediately if they experience chest pain. This is because chest pain can be a sign of a heart attack.

Hiatus hernia: symptoms, causes, diagnosis, treatment

Content

• 1 Hiatus hernia: symptoms, causes and treatment
  • 1.1 Description of hiatal hernia
    • 1.1.1 What is it?
  • 1.2 Causes of hiatal hernia
  • 1. 3 Symptoms of hiatal hernia
  • 1.4 Diagnosis of hiatal hernia
    • 1.4.1 Symptoms
    • 1.4.2 Diagnosis
  • 1.5 Treatment of hiatal hernia without surgery
    • 1.5.1 Medical treatment
    • 1.5. 2 Diet
    • 1.5.3 Physical activity
    • 1.5.4 Acupuncture
  • 1.6 Surgical treatment of hiatal hernia
    • 1.6.1 Indications for surgery
    • 1.6.2 Types of surgery
    • 1.6.3 Operation
    • 1.6.3 6.4 Postoperative period
  • 1.7 Recovery after hiatal hernia surgery
    • 1.7.1 Recommendations after surgery
    • 1.7.2 Exercise for recovery
    • 1.7.3 Recovery time after surgery

    900 11

    • 1.8 Complications of hiatal hernia openings of the diaphragm
      • 1.8.1 1. Erosion and ulcer of the esophagus
      • 1.8.2 2. Stricture (stenosis) of the esophagus
      • 1.8.3 3. Bleeding
      • 1.8.4 4. Esophageal dystrophy
    • 1. 9 Prevention of hiatal hernia
      • 1.9.1 Maintaining a healthy lifestyle
      • 1.9.2 Foods that reduce the risk of hernia

      90 005 1.9.3 Correct posture while eating

      • 1.9.4 Reducing stress
    • 1.10 When to see a doctor for hiatal hernia
    • 1.11 Related videos:
    • 1.12 Q&A:
      • • 1.12.0.1 What causes hiatal hernia?
        • 1.12.0.2 What symptoms may accompany hiatal hernia?
        • 1.12.0.3 How is hiatal hernia diagnosed?
        • 1.12.0.4 How is hiatal hernia treated?
        • 1.12.0.5 What precautions can be taken to prevent hiatal hernia?
        • 1.12.0.6 What are the consequences of delayed treatment of hiatal hernia?

  Hiatal hernia is a serious disorder of the digestive system that can lead to dangerous complications. In the article we will talk about the causes, symptoms, diagnosis and treatment of this disease. Learn how to prevent hernia and restore health.

  Hiatal hernia is a disease in which part of the stomach protrudes from the abdominal cavity through a hole in the diaphragm into the chest cavity. This leads to disruption of the esophagus, which passes through the diaphragm on its way from the throat to the stomach. Hiatus hernia is a serious problem that can cause various complications if not treated on time.

  The causes of hiatal hernia may be a violation of the muscle tone of the diaphragm, excess weight, pressure on the abdominal cavity, stretching of the ligaments, etc. Signs of the disease may include reflux (leakage of acidic fluid from the stomach into the esophagus), difficulty swallowing, rapid heart rate, chest pain, and difficulty breathing.

  The diagnosis of hiatal hernia includes examination by a physician, endoscopy and X-ray. Treatment may include removing the cause of the disease (eg, weight bearing), exercises to strengthen the muscles of the diaphragm, drug therapy, and, in severe cases, surgery.

  Description of hiatal hernia

  What is it?

  Hiatus hernia is a common condition where the upper abdomen pulls through the diaphragm and moves into the chest cavity.

  A hiatal hernia can be confirmed through an examination such as X-ray, endoscopy, or magnetic resonance imaging.

  Further treatment may include simple lifestyle changes such as dietary changes or not eating before bed, as well as drugs or surgery, depending on the severity and duration of the disease.

  Causes of hiatal hernia

  Stretching of the muscles and ligaments in the diaphragm can lead to hiatal hernia. This is due to the rapid repetition of the same movements, as well as the features of professional activity.

  Chronic diseases , such as heartburn, stomach ulcers, diseases of the esophagus, can also cause hiatal hernia.

  Obesity is one of the main risk factors for hiatal hernia. Excess weight puts extra stress on the diaphragm and causes it to stretch.

  Smoking may cause tissue damage in the area of ​​the diaphragm, which may contribute to hiatal hernia. Nicotine constricts blood vessels, which disrupts blood circulation in tissues.

  Genetic predisposition can also cause hiatal hernia. Hereditary factors can affect the initially weak structure of the diaphragm.

  Aging of the body is a natural process that can also affect the occurrence of hiatal hernia. As we age, body tissues lose elasticity and can be more easily damaged.

  Symptoms of hiatal hernia

  Hiatal hernia is a serious condition caused by extrusion of part of the stomach into the chest cavity through the diaphragm. A characteristic manifestation of the disease is reflux esophagitis, or inflammation of the esophagus. It occurs as a result of a stable reflux of gastric contents into the esophagus, which causes irritation and inflammation of the walls of the esophagus. Among the main symptoms of hiatal hernia are the following:

  • Heartburn sensation is the most common symptom of hiatal hernia. It is manifested by an unpleasant burning sensation in the chest, which extends to the throat. The sensation can be heavy and often occurs after eating or light exercise.
  • Chest pains – Pain resulting from irritation of the walls of the esophagus and may be severe and prolonged. To diagnose a hernia of the esophageal opening of the diaphragm, an accurate differentiation from heart pain is necessary.
  • Nausea and vomiting – these symptoms often occur after eating and may be associated with backflow of stomach contents.
  • Severe constipation – occurs as a result of impaired bowel function and may be caused by changes in the location of the digestive organs.
  • Iron deficiency – occurs due to bleeding as a result of the disease. It can manifest itself in the form of anemia, weakness and increased fatigue.

  If you experience these symptoms, you should see a doctor for diagnosis and treatment.

  Diagnosis of hiatal hernia

  Symptoms

  Hiatal hernia can present with a variety of symptoms that may be related to digestion, breathing, or the cardiovascular system. Some of the symptoms:

  1. Chest pain and discomfort
  2. Acidity and heartburn
  3. Heaviness after eating or at night
  4. Difficulty swallowing
  5. Cough or shortness of breath
  6. Palpitations and feelings of impotence

  Diagnosis

  Esophagogastroduodenoscopy (EGD) is the main method for diagnosing hiatal hernia. During this examination, the doctor can see the hernia and evaluate its size and shape.

  An X-ray of the chest and abdomen with contrast can also be prescribed, which allows you to assess the condition and size of the hernia in more detail, as well as identify possible complications.

  Treatment of hiatal hernia without surgery

  Medical treatment

  If a patient has a small hiatal hernia, the doctor may prescribe medication. Medications can help reduce stomach acid and protect the esophagus from damage. It is important to follow the dosage and doctor’s recommendations to avoid side effects.

  Diet

  In case of hiatal hernia, it is not recommended to consume spicy, acidic and fatty foods, as well as drinks containing caffeine. To reduce pressure in the stomach, you should eat food little by little, but more often – 5-6 times a day in small portions. Patients are also advised to observe certain rules for eating – do not eat before bed and do not bend over after eating.

  Physical activity

  Regular exercise can help strengthen the muscles of the diaphragm and abdomen, which will reduce the risk of a hernia recurring. But at the same time, you should not engage in too intense sports, which can cause increased pressure in the abdomen.

  Acupuncture

  Acupuncture is an alternative medicine that can help with hiatal hernia. This method is based on the impact on active points on the human body with the help of needles. Acupuncture can help reduce symptoms associated with a hernia, such as heartburn and belching.

  Surgical treatment of hiatal hernia

  Indications for surgery

  Surgical treatment of hiatal hernia is performed when conservative methods fail and the patient continues to experience pain, difficulty in swallowing, heartburn, recurrent pneumonia or asthma.

  Types of surgery

  There are several types of surgery to treat hiatal hernia: laparoscopic Nissen-von-Rheingoldt surgery, fundoplication, thoracotomy, etc.

  Fundoplication is a method in which the upper part of the stomach is wrapped around the lower esophagus and fixed. This type of operation is used most often for recurrence of hernia of the esophageal opening of the diaphragm.

  Surgery

  Before surgery, the patient is given a complete blood count, urine test, bacteriological tests to detect the presence of infection. Two hours before the operation you need to stop eating and drinking. The surgeon performs the operation under anesthesia. The duration of the operation depends on the complexity of the pathological process and the chosen method of treatment. After the operation, the patient is in intensive care under the supervision of doctors.

  Postoperative period

  The patient must observe the regimen of the postoperative period: limit physical activity, use of fatty, spicy, spicy foods, stop smoking and alcohol. Take your medications as prescribed by your doctor. After removing the sutures and increasing physical activity, patients should see a specialist to adjust their exercise regimen.

  Recovery after hiatal hernia surgery

  Advice after surgery

  After surgery, it is important to take care of your health by following the recommendations of specialists. In the first days after the operation, it is necessary to limit physical activity, not to make sudden movements.

  It is also important to take anti-inflammatory drugs and antibiotics if prescribed by the supervising physician. If pain symptoms or other abnormalities appear, you should immediately consult a doctor.

  Physical exercise for recovery

  Exercise can speed up the recovery process after surgery. But during the period of leveling the condition, it is necessary to avoid physical exercises that can be detrimental to health.

  Examples of exercises that can be done after a period of rehabilitation are yoga exercises, swimming and Pilates. You can also do exercises to strengthen the abdominal muscles, which will help reduce the risk of a hernia recurring.

  Recovery time after surgery

  The length of the recovery period after surgery is always individual and depends on many factors such as age, presence of concomitant diseases, general health, etc.

  A full recovery usually takes 2 to 6 months, although in some cases a longer recovery period may be required. During this period, it is important to follow all the recommendations of doctors and monitor your well-being.

  Complications of hiatal hernia

  1. Erosion and ulceration of the esophagus

  Hiatus hernia can lead to the development of erosions and ulcers in the wall of the esophagus. This is due to the fact that the acidic contents of the stomach are poured into the esophagus and irritate its walls. Over time, this can lead to the formation of ulcers, which can be dangerous if not treated promptly.

  2. Strictures (stenoses) of the esophagus

  In some cases, hiatal hernia can lead to the formation of strictures (stenoses) of the esophagus. Strictures are narrow places in the esophagus where food can be obstructed. This can cause pain and discomfort when eating, and lead to complications if not treated promptly.

  3. Bleeding

  If hiatal hernia is complicated by erosions and ulcers of the esophagus, there may be a risk of bleeding. This disorder can be life-threatening and requires immediate medical attention.

  4. Esophageal dystrophy

  In hiatal hernia, the walls of the esophagus may become less elastic and thin, which can lead to esophageal dystrophy. This allows food to linger in the esophagus, which creates favorable conditions for the development of infection and other complications.

  Prevention of hiatal hernia

  Maintaining a healthy lifestyle

  Non-observance of a healthy lifestyle is one of the main causes of hiatal hernia. To prevent the development of this disease, it is necessary to eat right and control weight. It is important to stop smoking and drink alcohol in moderation. Regular exercise can also help prevent hernia.

  Products that reduce the risk of hernia

  Nutrition is one of the factors that can influence the development of hiatal hernia. For prevention, it is recommended to consume natural products, including vegetables and fruits. Dark chocolate and olive oil may also help reduce the risk of hernia.

  Correct body position during meals

  After eating, it is not recommended to lie down immediately, it is better to keep the body upright for several hours. In this case, it is important not to burden the stomach, to observe the measure in food intake. Don’t put off eating until late in the evening, as this can lead to indigestion.

  Stress reduction

  Emotional stress can contribute to hernia. To prevent the development of the disease, it is recommended to engage in meditation, yoga, and any other ways of relaxation. It is also helpful to take more time to rest and sleep.

  When to see a doctor for hiatal hernia

  Hiatal hernia is a serious disease that can lead to various complications in the human body. Therefore, at the first signs of the disease, you should seek help from a doctor.

  • If you frequently experience vomiting, nausea, and a stuffy throat, this could be a sign of a hiatal hernia.
  • If you have persistent chest pain that gets worse with exercise, this may also indicate a problem with your digestive system.
  • If you often experience sudden reflux of stomach contents while eating, you should immediately seek medical attention.

  It is important to remember that a hiatal hernia will not go away on its own without treatment and can lead to serious consequences. Therefore, if you have suspicions of this ailment, immediately seek the advice of a specialist.

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  Q&A:

  What are the causes of hiatal hernia?

  One of the main causes is weakness of the muscles of the diaphragm, which can occur as a result of various factors such as age, obesity, pregnancy, smoking, frequent weight lifting, etc.

  What symptoms can accompany hiatal hernia?

  The most striking symptom is heartburn, which can occur after eating, especially when lying on your back. There may also be a feeling of heaviness in the abdomen, vomiting, respiratory problems, chest pain, etc.

  How is hiatal hernia diagnosed?

  Various methods are used for diagnosis, including esophagogastroduodenoscopy, barium fluoroscopy, computed tomography, magnetic resonance imaging, etc.

  How is hiatal hernia treated?

  Treatment may be conservative or surgical. Conservative treatment includes medications that reduce stomach acid production and lifestyle changes such as quitting smoking, exercising regularly, and losing weight. Surgical treatment may be necessary for patients in whom conservative treatment does not lead to a positive result or in case of complications of a hernia.

  What precautions can be taken to prevent hiatal hernia?

  Hernia can be prevented by: maintaining a healthy lifestyle, avoiding overeating, eating at least 3 hours before bedtime, not smoking, regular exercise, and weight control.

  What are the consequences of delayed treatment of hiatal hernia?

  Untimely treatment of a hernia can lead to various complications, such as congestion in the lungs, development of bronchitis, perforation of the stomach, etc. In some cases, a hernia can lead to the development of cancer of the esophagus.

  Hiatal hernia – Clinic 29

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

  Diaphragmatic hernia is caused by increased elasticity of the tissues that limit the esophageal opening of the diaphragm, the ligament between the diaphragm and the esophagus, one of the legs of the diaphragm. Increased elasticity of the aperture of the diaphragm may be congenital. Sometimes there is an anomaly of development – the so-called “short esophagus with a chest 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. This is 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 ligaments and connective tissue with age matters.

  At the beginning of the disease, the displacement of the organs of the abdominal cavity into the chest cavity occurs periodically, under the influence of physical exertion, coughing, vomiting, overeating, etc. Then such a 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 final section of the esophagus with part of the stomach falls into the esophageal opening of the diaphragm.

  Symptoms

  One of the most common complaints is heartburn (due to reflux of stomach contents into the esophagus). With a hernia of the POD, heartburn often occurs at night or after eating. Heartburn can also occur after exercise, and is often accompanied by pain.
  Pain in hiatal hernia occurs in 40-50% of patients. The pain is quite intense, felt retrosternally, has a burning character and, therefore, is often confused by patients with pain in angina pectoris. Pain with a hernia of the esophagus is most often associated with bending, physical activity and is aggravated by lying down. Pain in hiatal hernia is often accompanied by reflux of food into the esophagus and. With a change in body position, the pain often subsides.

  The next common symptom of hiatal hernia is belching. Belching – involuntary sudden release of gases through the mouth from the stomach or esophagus, sometimes with an admixture of stomach contents, occurs in 30 – 73% of patients. Belching 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 is ineffective, only belching a significant amount of food brings relief.

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

  A complication of hiatal hernia is most often reflux esophagitis, but a peptic ulcer of the esophagus may develop, with a long course of which, in turn, cicatricial stenosis (narrowing) of the esophagus may occur.