What are the common symptoms of a hiatal hernia. How is a hiatal hernia diagnosed. What are the most effective treatments for managing a hiatal hernia. When does a hiatal hernia require surgical intervention.

Understanding Hiatal Hernias: Types and Mechanisms

A hiatal hernia occurs when a portion of the stomach protrudes through the diaphragm into the chest cavity. This condition involves the hiatus, an opening in the diaphragm that allows the esophagus to connect to the stomach. There are two primary types of hiatal hernias:

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

Understanding the difference between these types is crucial for proper diagnosis and treatment. While sliding hernias are generally less concerning, paraesophageal hernias can lead to more severe complications if left untreated.

Recognizing the Symptoms of Hiatal Hernia

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

• Heartburn, often related to gastroesophageal reflux disease (GERD)
• Chest pain or discomfort
• Bloating and burping
• Difficulty swallowing (dysphagia)
• Regurgitation of food or liquids into the mouth
• A bad taste in the mouth
• Shortness of breath

Is chest pain always indicative of a hiatal hernia? Chest pain can be a symptom of various conditions, including heart problems, so it’s essential to consult a healthcare provider for proper diagnosis.

Causes and Risk Factors Associated with Hiatal Hernias

The exact cause of hiatal hernias is not always clear, but several factors may contribute to their development:

• Congenital factors: Being born with a larger hiatal opening
• Injury to the diaphragm or surrounding area
• Age-related changes in the diaphragm
• Increased abdominal pressure due to pregnancy, obesity, coughing, or heavy lifting

Certain groups are at higher risk of developing hiatal hernias:

• Women
• Individuals over 50 years old
• People who are overweight or obese

Can lifestyle changes reduce the risk of developing a hiatal hernia? While some risk factors are unavoidable, maintaining a healthy weight and avoiding activities that increase abdominal pressure may help reduce the risk.

Diagnostic Procedures for Hiatal Hernias

To diagnose a hiatal hernia, healthcare providers may employ various diagnostic techniques:

1. Barium swallow: A special X-ray that provides a clear view of the esophagus and stomach
2. Endoscopy: A procedure using a thin, flexible tube with a camera to examine the upper digestive tract
3. Esophageal manometry: A test to measure pressure within the esophagus during swallowing
4. pH test: A method to measure acid levels in the esophagus

In some cases, additional tests may be necessary to rule out other conditions or assess complications. For instance, a blood test may be performed to check for anemia if there are concerns about internal bleeding.

Treatment Options for Managing Hiatal Hernias

The treatment approach for hiatal hernias depends on the severity of symptoms and the type of hernia. For many individuals with mild symptoms, lifestyle changes and medications may be sufficient:

Medications:

• Antacids to neutralize stomach acid
• Proton pump inhibitors (PPIs) or H-2 receptor blockers to reduce acid production
• Prokinetics to strengthen the lower esophageal sphincter and improve stomach emptying

Lifestyle Modifications:

• Eating smaller, more frequent meals
• Avoiding lying down or exercising shortly after eating
• Elevating the head of the bed
• Avoiding trigger foods such as acidic, fried, or fatty foods
• Quitting smoking
• Losing excess weight

Are there any natural remedies that can help manage hiatal hernia symptoms? While not a substitute for medical treatment, some individuals find relief through practices like stress reduction techniques, herbal teas, and gentle exercises that strengthen the diaphragm.

Surgical Interventions for Hiatal Hernias

In some cases, surgery may be necessary to treat a hiatal hernia, particularly for paraesophageal hernias or when other treatments fail to provide relief. Surgical options include:

• Laparoscopic surgery: A minimally invasive procedure using small incisions and a camera-guided approach
• Open surgery: A traditional surgical method used in more complex cases

During surgery, the physician will typically:

1. Return the stomach to its proper position below the diaphragm
2. Repair and reinforce the hiatal opening
3. Sometimes perform a procedure to prevent reflux (fundoplication)

When is surgery considered necessary for a hiatal hernia? Surgery is typically recommended for paraesophageal hernias due to the risk of complications, or when symptoms are severe and unresponsive to conservative treatments.

Recovery and Long-term Management After Hiatal Hernia Treatment

Recovery from hiatal hernia treatment, especially after surgery, requires patience and adherence to post-treatment guidelines:

• Following a soft or liquid diet for several weeks post-surgery
• Gradually reintroducing solid foods as advised by the healthcare provider
• Avoiding heavy lifting and strenuous activities for a specified period
• Attending follow-up appointments to monitor recovery progress

Long-term management often involves continuing lifestyle modifications and, in some cases, ongoing medication use to prevent symptom recurrence.

How long does it typically take to recover from hiatal hernia surgery? While individual experiences may vary, most patients can return to normal activities within 2-4 weeks after laparoscopic surgery, with full recovery taking up to 6-8 weeks.

Potential Complications and When to Seek Emergency Care

While many hiatal hernias are manageable, certain complications can arise, particularly with paraesophageal hernias:

• Strangulation: When the blood supply to the herniated portion of the stomach is cut off
• Obstruction: Blockage of the passage of food or liquids through the digestive tract
• Bleeding: Potentially leading to anemia if chronic or severe

Emergency medical attention is crucial if you experience:

• Severe, persistent chest or abdominal pain
• Difficulty swallowing or breathing
• Vomiting, especially if the vomit is bloody or looks like coffee grounds
• Inability to have a bowel movement or pass gas

Can a hiatal hernia become life-threatening? While rare, severe complications like strangulation can indeed be life-threatening if not addressed promptly, underscoring the importance of seeking immediate medical care when concerning symptoms arise.

Innovative Approaches and Future Directions in Hiatal Hernia Management

As medical science advances, new approaches to managing hiatal hernias are emerging:

• Robotic-assisted surgery: Offering enhanced precision and potentially faster recovery times
• Endoscopic techniques: Less invasive methods for repairing small hernias or managing symptoms
• Magnetic sphincter augmentation: A novel approach to preventing acid reflux in patients with hiatal hernias

Research is ongoing to improve diagnostic accuracy, develop more effective treatments, and understand the long-term outcomes of various management strategies.

How might future technologies change the landscape of hiatal hernia treatment? Advancements in imaging techniques, minimally invasive surgical tools, and personalized medicine approaches may lead to more targeted and effective treatments with fewer side effects.

In conclusion, hiatal hernias, while common, present a spectrum of challenges in diagnosis and management. From asymptomatic cases requiring no intervention to complex scenarios necessitating surgical repair, the approach to hiatal hernias must be tailored to each individual’s specific circumstances. By understanding the types, symptoms, and treatment options available, patients and healthcare providers can work together to develop effective management strategies that improve quality of life and prevent potential complications.

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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Hernia of the esophageal opening of the diaphragm – diagnosis and treatment in St. Petersburg, price

Hernia of the esophageal opening of the diaphragm – causes

A congenital wide opening is a predisposing factor. The cause of the hit may be a functional factor – reverse peristalsis, which is a manifestation of gastroesophageal reflux disease (GERD). Processes leading to an increase in abdominal pressure can also be producing factors – injuries, constipation, prolonged coughing, pregnancy, obesity, etc.

Basically, these hernias are divided into sliding and paraesophageal. Also, a hernia can be fixed and even strangulated.

Basic diagnostic methods for hiatal hernia

The initial diagnostic method is video gastroduodenoscopy (VGDS) , in which it becomes clear that part of the stomach is temporarily or permanently above the set level (diaphragm crus). To confirm the diagnosis and the final diagnosis of the hernia form, fluoroscopy of the esophagus and stomach is necessary with special tests. Other diagnostic methods are of an auxiliary nature.

The purpose of diagnostics is to determine the form of the hernia and the degree of change in the esophagus with its obligatory histological examination to determine the type and amount of assistance needed.

The reason for the examination are signs of a violation of the function of the transition of the esophagus to the stomach:

• heartburn,
• burps,
• feeling of bitterness or acidity in the mouth,
• regurgitation of food,
• sensation of “food stuck in the lower part of the sternum,
• retrosternal pain during eating and at night,
• unmotivated nocturnal cough.

Basic methods of treatment of hiatal hernia

Treatment of a sliding hernia in the initial stages can be conservative (diet, diet, medication). In the case of a strangulated and fixed hernia, there is no alternative to surgical treatment. With painful functional problems that the patient regards as unacceptable, and with the ineffectiveness of conservative treatment, as well as with the appearance of precancerous changes in the esophagus (Barrett’s esophagus, severe forms of metaplasia), surgical treatment is necessary.

A reliable method of surgery with proven effectiveness is Nissen esophagofundoplication with posterior crurorraffia (hernia repair and creation of conditions for the normal functioning of the esophagogastric junction).

Patient essential

Conservative and surgical treatment of hiatal hernia should be carried out in specialized medical institutions with a sufficient level of diagnostic and surgical equipment.

It must be understood that surgical treatment of a hiatal hernia is performed according to clear indications: when there is a direct threat of esophageal cancer, hernia incarceration or pain, and functional disorders are not amenable to conservative treatment. In the postoperative period, certain functional disorders may appear and persist due to the complexity of anatomical and functional relationships, which change in a positive direction during surgery, but require adaptation from several weeks to several months.

In our Clinic, we are ready to offer a full range of diagnostic and therapeutic measures. Surgical treatment of hiatal hernia is performed laparoscopically, which can dramatically reduce the likelihood of postoperative complications. The length of stay in the hospital after surgery is usually 1-2 days.

Diaphragmatic hernia – symptoms, methods of diagnosis and treatment

Author

Samokhvalova Nina Igorevna

Leading physician

Gastroenterologist

Creation date: 2020.05.19

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Hiatus hernia (diaphragmatic hernia) occurs when through the esophageal opening of the diaphragm – the hole through which the esophagus from the chest cavity penetrates into the abdominal – abdominal part of the esophagus, part of the stomach or abdominal part of the esophagus, together with part of the stomach, is displaced into 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.

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.

A complication of a hernia of the esophageal opening of the diaphragm 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. There are acute and chronic bleeding from the esophagus, perforation of the esophagus, or strangulated hernia in the esophageal opening of the diaphragm.

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Diaphragmatic hernia causes

The cause of diaphragmatic hernia is the increased elasticity of the tissues that limit the esophageal opening of the diaphragm. Such elasticity may be innate. Sometimes there is an anomaly of development – the so-called “short esophagus with a thoracic 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: heavy 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.

Diaphragmatic hernia symptoms

One of the most common complaints is heartburn (due to reflux of stomach contents into the esophagus).

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 slopes, physical activity and is aggravated by lying down. With a change in body position, the pain often subsides.

Difficulty in the passage of food through the esophagus with a hernia of the esophageal opening of the diaphragm 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.

Heartburn

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.

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Belching

Another 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.

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Diagnostic methods for diaphragmatic hernia

Diagnosis of hernia of the esophageal opening of the diaphragm is established by x-ray examination.