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Hiatal hernia symptoms fatigue. Hiatal Hernia: Symptoms, Causes, and Treatment Options

What are the symptoms of a hiatal hernia. How is a hiatal hernia diagnosed. What treatment options are available for hiatal hernias. When does a hiatal hernia require surgical intervention. How do different types of hiatal hernias affect patients differently.

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Understanding Hiatal Hernias: Types and Mechanisms

A hiatal hernia occurs when a portion of the stomach protrudes through the hiatus, an opening in the diaphragm that allows the esophagus to connect to the stomach. There are two main types of hiatal hernias:

  • Sliding hiatal hernia
  • Paraesophageal hernia

In a sliding hiatal hernia, the lower esophageal sphincter and a small part of the stomach slide upward through the hiatus. This type is more common and often associated with gastroesophageal reflux disease (GERD).

Paraesophageal hernias are less common but potentially more serious. In this type, a portion of the stomach pushes through the hiatus and sits next to the esophagus. In severe cases, known as giant esophageal hernias, the entire stomach and even parts of the intestines may migrate into the chest cavity.

Recognizing the Signs and Symptoms of Hiatal Hernias

Many small hiatal hernias are asymptomatic, but larger hernias or those causing complications can present various symptoms:

  • Heartburn and acid reflux
  • Difficulty swallowing (dysphagia)
  • Chest pain, especially after eating
  • Regurgitation of food or liquids
  • Shortness of breath
  • Fatigue
  • Anemia (in some cases)

Can hiatal hernias cause fatigue? Yes, fatigue can be a symptom of hiatal hernias, especially in cases where the hernia is large or causing significant reflux. This fatigue may be due to discomfort, sleep disturbances from reflux symptoms, or in some cases, anemia resulting from chronic bleeding.

Risk Factors and Causes of Hiatal Hernias

Several factors can increase the risk of developing a hiatal hernia:

  1. Age (more common in people over 50)
  2. Obesity
  3. Pregnancy
  4. Smoking
  5. Chronic coughing or vomiting
  6. Heavy lifting or straining
  7. Genetic predisposition

Why do these factors contribute to hiatal hernia development? Many of these risk factors increase intra-abdominal pressure, which can push the stomach upward through the hiatus. Others, like smoking and genetic factors, may weaken the supporting tissues around the hiatus, making it easier for herniation to occur.

Diagnostic Approaches for Hiatal Hernias

Diagnosing a hiatal hernia typically involves one or more of the following procedures:

  • Barium swallow (upper GI series)
  • Endoscopy
  • CT scan
  • Manometry

How does a barium swallow help diagnose hiatal hernias? During this test, the patient swallows a barium solution, which shows up on X-rays. This allows doctors to visualize the esophagus, stomach, and upper intestine, potentially revealing the presence and size of a hiatal hernia.

The Role of Endoscopy in Diagnosis

Endoscopy involves inserting a thin, flexible tube with a camera down the throat and into the esophagus and stomach. This procedure allows doctors to directly visualize the upper digestive tract, identify hernias, and assess for complications like esophagitis or Barrett’s esophagus.

Conservative Management of Hiatal Hernias

For many patients with small, uncomplicated hiatal hernias, conservative management is often sufficient. This may include:

  • Dietary modifications (avoiding trigger foods, eating smaller meals)
  • Lifestyle changes (weight loss, smoking cessation)
  • Medications (antacids, H2 blockers, proton pump inhibitors)
  • Elevating the head of the bed

How effective are these conservative measures? For many patients with mild symptoms, these approaches can significantly reduce discomfort and improve quality of life. However, they may not be sufficient for larger hernias or those causing severe symptoms.

Surgical Interventions for Hiatal Hernias

Surgery may be recommended for hiatal hernias in certain situations:

  • When symptoms are not controlled with medication
  • For large paraesophageal hernias
  • When complications like strictures or severe inflammation occur

Common surgical procedures for hiatal hernia repair include:

  1. Nissen fundoplication
  2. Collis-Nissen gastroplasty
  3. Laparoscopic hiatal hernia repair

Understanding Nissen Fundoplication

Nissen fundoplication is a common surgical procedure for hiatal hernia repair. During this operation, the surgeon wraps the upper part of the stomach (fundus) around the lower esophagus, creating a tighter sphincter to prevent reflux and keep the stomach in place.

What are the benefits of Nissen fundoplication? This procedure can effectively reduce reflux symptoms, repair the hernia, and often eliminates the need for long-term medication use. It’s typically performed laparoscopically, resulting in shorter recovery times and less postoperative pain compared to open surgery.

Complications and Long-term Outlook for Hiatal Hernia Patients

While many hiatal hernias are benign and cause minimal symptoms, some can lead to complications if left untreated:

  • Chronic GERD and its associated risks (Barrett’s esophagus, esophageal cancer)
  • Strangulation of the hernia (a medical emergency)
  • Gastric volvulus (twisting of the stomach)
  • Iron-deficiency anemia

Can hiatal hernias resolve on their own? Small sliding hiatal hernias may occasionally resolve spontaneously, especially in children. However, in adults, hernias typically do not “heal” without intervention, though symptoms can often be managed effectively with conservative measures or surgery.

Post-surgical Outcomes and Quality of Life

Most patients who undergo hiatal hernia repair experience significant improvement in their symptoms and quality of life. Success rates for laparoscopic hiatal hernia repair are generally high, with many patients reporting complete resolution of their reflux symptoms.

What is the recurrence rate after hiatal hernia surgery? Recurrence rates vary depending on the type of hernia and surgical technique used, but are generally low, ranging from 5-15% in most studies. Factors that may increase recurrence risk include obesity, large hernia size, and certain surgical techniques.

Emerging Treatments and Future Directions in Hiatal Hernia Management

Research into hiatal hernia treatment continues to evolve, with several promising areas of development:

  • Robotic-assisted surgical techniques
  • Magnetic sphincter augmentation devices
  • Endoscopic fundoplication procedures
  • Improved mesh materials for hernia repair

How might these new treatments improve outcomes for hiatal hernia patients? These emerging techniques aim to provide more precise and less invasive treatment options, potentially reducing surgical complications and improving long-term success rates. For example, magnetic sphincter augmentation devices offer a reversible alternative to traditional fundoplication, which may be particularly beneficial for certain patient populations.

The Role of Personalized Medicine in Hiatal Hernia Care

As our understanding of the genetic and physiological factors contributing to hiatal hernias grows, there is increasing interest in personalized treatment approaches. This may involve tailoring surgical techniques or medication regimens based on individual patient characteristics, potentially improving outcomes and reducing complications.

What factors might influence personalized treatment decisions? Considerations may include the patient’s age, overall health status, hernia size and type, severity of symptoms, and genetic markers associated with tissue strength or healing capacity. By taking these factors into account, doctors may be able to offer more targeted and effective treatments in the future.

Hiatal Hernia | Columbia Surgery

In a hiatal hernia (also called hiatus or diaphragmatic hernia), a portion of the stomach penetrates (herniates) through a weakness or tear in the hiatus of the diaphragm, the small opening that allows the esophagus to pass from the neck and chest to its connection with the stomach. Often there are no symptoms, and the condition may not cause any problems. The patient may not be aware they have a hiatal hernia.

Sliding Hiatal Hernia

The term sliding is employed when hiatal hernia involves the lower esophageal sphincter where the esophagus attaches to the stomach. It can also involve a small portion of the stomach. The patient may experience heartburn and gastroesophageal reflux. Because reflux may damage the lining of the esophagus, treatment is essential. Symptoms can usually be managed with medications and behavior modification such as elevating the upper body on a pillow during sleep. Surgery may sometimes be required to correct a sliding esophageal hernia.

Paraesophageal Hernia and Intrathoracic Stomach

In more severe cases of hiatal hernia, the fundus, or upper portion of the stomach, may slide upward into the chest cavity through the hiatus. The condition occurs as an intensifying of a sliding hiatal hernia. In rare cases, the entire stomach and even some of intestines may migrate through the hiatus and rest on top of the diaphragm next to the esophagus, a condition known as giant esophageal hernia.

Giant Hiatal Hernias: Podcast by Lyall A. Gorenstein, MD »  

Risk Factors

Hiatal hernia is initiated by pressure in the abdomen occurring through:

  • Heavy lifting
  • Hard coughing or sneezing
  • Violent vomiting
  • Pregnancy and delivery
  • Obesity may also cause hiatal hernia because of pressure on the abdomen caused by extra weight.
  • Heredity
  • Smoking
  • Stress
  • Short esophagus (paraseophageal hernia)

Signs and Symptoms

Most small hiatal hernias do not cause symptoms. The most common symptom of hiatal hernia is gastroesophageal reflux (GERD).

Giant hiatal hernias may cause symptoms including heartburn/regurgitation, anemia, aspiration, chest pain associated with eating, vomiting after meals, difficulty swallowing, fatigue, and shortness of breath.

Symptoms of parasophageal hernia may include problems swallowing, fainting, and vomiting.

Diagnosis

Hiatal hernia is diagnosed with an upper GI series or endoscopy.

In an upper GI series, or a barium swallow, also called barium contrast X-ray, the patient swallows a solution of barium, a compound that will appear inside the body during X-ray so the physician may observe how fluid moves through the esophagus as well as the appearance of the stomach.

In esophagoscopy/endoscopy of the esophagus, a thin, flexible tube with a camera is inserted through the mouth into the esophagus, allowing the physician to view the interior of the esophagus and obtain small tissue samples for biopsy, if necessary.

Treatments

Hiatal hernias require repair for two main reasons:

  1. The patient’s reflux symptoms are not successfully controlled with GERD medication therapy.
  2. The patient has a giant esophageal hernia (also known as intrathoracic stomach.)

If surgical treatment is required, our surgeons nearly always use minimally invasive anti-reflux techniques, including laparoscopy and endoscopy, with the type of procedure used depending upon the amount of stomach that has migrated through the diaphragm into the chest. GERD medications are not necessary after surgery.

Repairing the Hiatus

An early-stage hiatal hernia may be repaired by decreasing the size of the enlarged hiatus (the opening in the diaphragm through which the esophagus travels on its way to the stomach). This is accomplished by means of sutures and a prosthetic mesh to reinforce the diaphragm tissue.

Nissen Fundoplication

To repair and prevent a sliding hiatal hernia, Nissen fundoplication involves wrapping of the fundus (upper part) of the stomach around the bottom portion of the esophagus to create a bulge of tissue that holds the stomach in place below the diaphragmatic hiatus. Nissen fundoplication also reinforces the lower esophageal sphincter and alleviates reflux when it is present.

Collis-Nissen Gastroplasty

Paraesophageal hernia and intrathoracic stomach may be complicated when a short esophagus pulls upward on the stomach. In Collis-Nissen gastroplasty, the surgeon uses the upper portion of the stomach to extend the esophagus and ease this tension. Our team routinely uses minimally invasive laparoscopy to perform this procedure, which was traditionally performed through a major chest incision.

Next Steps

If you are in need of help for an esophageal condition, we’re here for you. Call us now at (212) 305-1909 or fill out our online form to get started today.

Related Topics 

  • Achalasia
  • Barrett’s esophagus
  • Esophageal atresia
  • Esophageal cancer
  • Esophageal dilation
  • Esophagectomy
  • Gastroesophageal reflux disorder (GERD)
  • Hiatal hernia
  • Swallowing disorders/dysphagia

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