Hiatal Hernia Symptoms & Treatment

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A hiatal or hiatus hernia happens when part of your stomach comes up through the diaphragm, the muscle that separates your chest area from your stomach area (abdomen). The tube that leads from your mouth to your stomach (esophagus) goes through a part of the diaphragm called the hiatus. If the muscle around the hiatus is weak, the top part of your stomach can press up through the diaphragm into the chest area and you may need hiatal hernia treatments.

Symptoms of a hiatal hernia

With most instances of hiatal hernia, symptoms are not present and need no treatment. More serious hiatal hernia symptoms may include trouble swallowing, heartburn, belching, tiredness and chest pain. Schedule an appointment with your doctor if you have these possible hiatal hernia symptoms and they are causing you concern. If you’re feeling chest pain, call your doctor immediately, as this may be a sign of a more serious condition.

Getting a hiatal hernia diagnosis

To diagnose a hiatal or hiatus hernia, your doctor will perform a physical exam. They’ll talk to you about your symptoms of hiatal hernia and may order tests, including:

• Endoscopy: A flexible tube equipped with a light and tiny camera (endoscope) is inserted down your throat to see inside the esophagus and stomach. If needed, a tissue sample (biopsy) can be done during an endoscopy. These samples are examined in a lab to check for problems.
• pH monitoring: This test checks for stomach acid in your esophagus.
• Motility testing: This measures if the esophagus is working properly. A thin, flexible tube (catheter) is inserted into your nose, down the esophagus and into the stomach.

Hiatal hernia services & treatment

Hiatal hernia treatments may include these dietary and lifestyle recommendations:

• Eat smaller more frequent meals
• Avoid fatty foods, alcohol, chocolate, caffeine and peppermint
• Don’t smoke
• Maintain normal weight
• Do not lie down after eating
• Do not eat for three to four hours before bedtime
• Elevate your head by six inches with a pillow wedge

Over-the-counter or prescriptions medicines may be used for hiatal hernia treatments, such as:

• Antacids. These will address symptoms of hiatal hernia but won’t fix any damage stomach acid has caused in your esophagus.
• H-2 receptor blockers. These heartburn medications reduce the amount of acid the body makes. They can help relieve symptoms of hiatal hernia for longer periods of time.
• Proton pump inhibitors. These block the acid the body makes, which allows the esophagus to heal.

Sometimes your doctor’s suggestion for hiatal hernia treatment may include surgery.

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Hiatal Hernia | Johns Hopkins Medicine

What is a hiatal hernia?

Unlike ventral hernias, which protrude through the abdominal wall, a hiatal hernia occurs when the upper part of the stomach pushes up into the chest through a small opening in the diaphragm, the muscle that separates the abdomen from the chest. A hiatal hernia results in retention of acid and other contents since the stomach tends to get squeezed by this opening in the diaphragm. These acids and other substances can easily back up — reflux or regurgitate — into the esophagus.

There are four types of hiatal hernias. The vast majority of hiatal hernias are called type I, or sliding hiatal hernias. In this type, the stomach intermittently slides up into the chest through a small opening in the diaphragm. Type II, III and IV hiatal hernias are called paraesophageal hernias. They occur when a portion of the stomach pushes up into the chest adjacent to the esophagus.

Hiatal Hernia Causes

Hiatal hernias can occur for a number of reasons, including:

• Being born with an unusually large hiatus

• Injury or trauma to the area such as force from a seatbelt during an accident

• Obesity

• Persistent and intense pressure on the surrounding muscles caused by:

Hiatal Hernia Diagnosis

To identify a hiatal hernia, a health care provider may use multiple diagnostic techniques but will begin with a medical history and physical examination. The provider will inquire about and/or look for:

Additional diagnostics may include:

• Barium X-ray or CT of the upper digestive tract to identify the location and positioning of the gastric organs

• Endoscopy exam, during which your doctor passes a thin, flexible tube equipped with a light and video camera (endoscope) down the throat and into the esophagus and stomach to check for inflammation

Hiatal Hernia Treatments

The symptoms associated with hiatal hernia, such as acid reflux, can be treated with lifestyle changes and medication. Surgery may be necessary to repair the hiatal hernia.

Specific treatment for a hiatal hernia will be determined by your doctor based on multiple factors, including your general health, anatomy, extent and location of the hernia, and severity of symptoms such as acid reflux. Any instance in which the stomach or abdominal organs rotate or twist, causing severe pain, blockage and possible strangulation in which blood supply is lost, is always treated with emergency surgery.

Hiatal Hernia Lifestyle and Medication Treatments

Many people do not experience any symptoms related to their hiatal hernia, or their symptoms, like heartburn, are mild. Generally, the symptoms of hiatal hernias can be controlled with lifestyle changes and medication such as:

• Eating meals at least three to four hours before lying down

• Eating moderate to small portions of foods

• Limiting fatty foods, acidic foods (citrus fruits or juices), foods containing caffeine and alcoholic beverages

• Losing weight or maintaining a healthy weight

• Over-the-counter antacids or antihistamines; your physician may prescribe a stronger medication to manage your symptoms

• Sleeping in a slightly elevated position

• Smoking cessation

Hiatal Hernia Surgical Treatments

Surgery to repair a hiatal hernia is usually performed through small incisions during which the stomach and any other surrounding tissue are pulled down from the chest cavity and back into the abdomen. The surgeon will also make the opening in your diaphragm smaller and may reconstruct an esophageal valve to treat reflux.

Alternatively, hiatal hernia can be repaired through the chest.

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

    9000 5 1.6.2 Types of surgery

    • 1.6.3 Operation
    • 1.6.4 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
      • 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
    • 1.11.0.1 What causes hiatal hernia?
    • 1.11.0.2 What symptoms can accompany hiatal hernia?
    • 1.11.0.3 How is hiatal hernia diagnosed?
    • 1.11.0.4 How is hiatal hernia treated?
    • 1.11.0.5 What precautions can be taken to prevent hiatal hernia?
    • 1. 11.0.6 What are the consequences of delayed treatment of hiatal hernia?
• 1.12 Related videos:

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.

This will effectively affect a person’s quality of life, causing symptoms such as heartburn, difficulty swallowing, vomiting, a burning sensation in the chest cavity and pain in the chest.

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 changing the diet or not eating before bed, as well as drugs or surgery, depending on the severity and duration of the disease.

Causes of hiatal hernia

The consequences of stretching of muscles and ligaments in the area of ​​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 can lead 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

Hiatus 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:

• Feeling of heartburn 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 – pains are caused by irritation of the walls of the esophagus, they can 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 difficulty breathing
6. Palpitations and feeling of impotence 90 010

Diagnosis

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

In addition, an abdominal ultrasound (ultrasound) may be ordered to assess the condition of the internal organs that may be affected by the hernia.

An x-ray of the chest and abdomen with contrast can also be prescribed, which allows an even more detailed assessment of the condition and size of the hernia, as well as identifying 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.

Laparoscopic Nissen von Rheingoldt is the most common type of surgical treatment. This is a minimally invasive method that avoids large scars on the abdominal wall.

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.

The diet should be light and digestible without intimidating the digestive system. It is worth giving up fatty, spicy and sour foods, as well as smoking and alcohol. Multiple meals in small portions are recommended.

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.

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.

Length of recovery after surgery

The length of recovery after surgery is always individual and depends on many factors such as age, comorbidities, 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 ulcer of the esophagus

Hiatus hernia can lead to 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. Dystrophy of the esophagus

In hiatal hernia, the walls of the esophagus can become less elastic and thin, which can lead to the development of dystrophy of the esophagus. 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.

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.

Related videos:

Hiatal hernia – HH symptoms and treatment

Table of contents

Hiatal hernia affects several organs in combination. The esophagus passes into the epigastrium through the hiatal opening in the diaphragm, and hiatal hernia occurs when part of the stomach is forced into the chest cavity. The most vulnerable are considered to be pregnant women, people over 50 and obese. Also, a hernia of the esophageal opening of the diaphragm can be caused by excessive strength exercises, lifting heavy loads, excessive stress during bowel movements, etc. Hiatal hernia of the diaphragm is predominantly an acquired disease, but hereditary cases are also observed. With the manifestation of relevant symptoms and the identification of HH, a decision is made to perform an operation to remove the hernia. In some cases, you can try to do conservative treatment without surgery, but this method is not applicable to all types of HH and only temporarily relieves the symptoms of the disease.

Varieties of HH

Hiatal hernia is classified based on the specifics of displacement and two key types are distinguished in its typology: treatment in a hospital.

In addition, there are several stages of severity of the course of the disease (stages I, II, III and IV) based on the degree of transition of the stomach into the sternal region.

Factors affecting the development of HH

HH develops due to a pathological change in the size of the esophageal opening. With minor deviations from the permissible values, a hernia of the esophageal opening of the diaphragm does not show symptoms until a targeted diagnosis, and the signs of HH are easily confused with manifestations of other diseases of the gastrointestinal tract or from the cardiovascular system.

Hernia of the alimentary opening of the diaphragm can manifest itself due to many circumstances and is currently increasingly common in medical practice.

Main factors for the development of HH:

• muscle hypotension due to age;
• chronic diseases of the gastrointestinal tract;
• intra-abdominal hypertension;
• weight fluctuation;
• complications from operations on the esophagus;
• a consequence of traumatization of the abdomen.

As for the complications that hiatal hernia can provoke, the most common is reflux esophagitis. The obvious symptoms of reflux esophagitis include regular bouts of heartburn after eating. Usually this complication is inherent if the patient has a sliding (axial) hiatal hernia, and as a treatment, the patient is prescribed therapy that normalizes acidity. Erosions of the esophagus and stomach are also quite often manifested, which in turn, if not detected and treated in time, can lead to a precancerous state of latent gastrointestinal bleeding and, as a result, cause anemia. Moreover, hiatal hernia can lead to peritonitis and sepsis due to compression of the hernia. With obvious symptoms of intoxication, vomiting, acute persistent pain, hospitalization is indicated as soon as possible.

Hiatal hernia is more often asymptomatic, but at the same time has a number of symptoms that may indicate the presence of the disease.

Symptoms of HH

Often HH is so small that it is hidden, but in more severe cases the following symptoms occur:

• frequent heartburn;
• belching;
• hiccups;
• difficulty and discomfort in swallowing;
• extremely fast satiety;
• sharp pains in chest;
• sore tongue;
• attacks of dry cough.

As practice shows, a patient with a confirmed diagnosis of hiatal hernia usually suffers immediately from a number of symptoms and needs treatment based on the diagnosed type of HH.

For correct treatment it is necessary to carry out a complete diagnosis, taking into account the most detailed questioning of the patient for the presence of symptoms, data on acidity and indicators of hernia. Hiatus hernia is detected by contrast radiography, esophageal motility studies, gastroscopy with biopsy, and daily pH-metry.

Outpatient treatment of HH

Treatment of HH begins with conservative methods, if the severity of the symptoms and the severity of the disease allow. Since a hernia of the esophageal opening of the diaphragm can proceed in a latent form for a long time and with a high degree of probability the patient has already taken certain actions to alleviate his condition, first of all, they conduct detailed consultations with a gastroenterologist to determine the correct treatment tactics. There are general rules, following which you can significantly improve the quality of life:

• adhere to the fractional meal plan;
• limit the consumption of certain foods that cause heartburn and adversely affect the digestive tract;
• do not lie down for 3 hours after eating;
• stop drinking alcohol and smoking.

It should be added that conservative treatment implies only the relief of symptoms of reflux esophagitis and is effective only at the initial stage of HH.

Surgical treatment of HH

If negative dynamics persist, doctors may decide that surgery is necessary. This is a more radical way of treatment, but also more effective, especially in case of acute exacerbations of the disease and if the hiatal hernia has developed into stages III and IV. Often, a hernia of the esophageal opening of the diaphragm can be accompanied by a number of other diseases of the gastrointestinal tract, therefore, in such cases, complex treatment is performed. Today, surgeons prefer laparoscopic operations due to their low trauma and reduced time for postoperative recovery.

Since a hernia of the esophageal opening of the diaphragm significantly disrupts the normal arrangement and functioning of several organs of the abdominal and sternal regions, the operation to eliminate it consists in performing a number of established manipulations:

Fundoplication, as a rule, is performed by the following methods:

• the author’s method of Academician A.F. Chernousov, the founder of antireflux surgery in Russia; This is a laparoscopic fundoplication, due to which a lasting effect is achieved with a recurrence probability of only 2% within a year from the moment of operation.
• Nissen fundoplication involves the formation of a cuff around the esophagus to maintain the correct functioning of its lower sphincter.