What Is a Hiatal Hernia?

A hiatal hernia occurs when the upper part of the stomach protrudes through an opening in the diaphragm into the chest cavity. The diaphragm is a muscular barrier separating the abdomen from the chest. It's termed a hernia when organs or tissues breach through weak spots in their enclosing structures. Hiatal hernias are particularly common among hernias.

Types of Hiatal Hernias

There are two primary types:

• Type 1 (Sliding Hiatal Hernia): This is the most prevalent type, in which the junction of the esophagus and stomach slides intermittently up through the diaphragmatic opening.
• Types 2-4 (Paraesophageal Hiatal Hernias): These less common types involve the stomach pushing alongside the esophagus through the hiatus, resulting in a bulge next to it.

Prevalence

Hiatal hernias become more common with age. Approximately 20% of the general population is affected, with prevalence increasing to 50% in those over 50, 60% in those over 60, and 70% in those over 70.

Symptoms and Causes

Symptoms: Most people with sliding hiatal hernias do not experience noticeable symptoms directly related to the hernia. However, symptoms often manifest as chronic acid reflux, known as gastroesophageal reflux disease (GERD). These include:

• Heartburn: a burning sensation in the chest following meals.
• Noncardiac chest pain resembling angina.
• Indigestion: feeling full soon after eating with abdominal pain.
• Burping: regurgitation of food, gas, or acid into the throat.
• Difficulty swallowing or a sensation of a lump in the throat.
• Sore throat or hoarseness due to acid irritation.

Causes: A hiatal hernia develops gradually over time due to the widening of the esophageal hiatus, where the esophagus passes through the diaphragm. Chronic stress and strain can exacerbate this opening, allowing the upper stomach to break through.

Complications

While most hiatal hernias do not cause serious issues, complications can arise, particularly with larger paraesophageal hernias. These may include:

• Esophagitis: Inflammation of the esophagus due to chronic acid exposure.
• Esophageal stricture: Narrowing of the esophagus from scar tissue.
• Barrett’s esophagus: Precancerous changes in the esophageal lining.
• Rarely, gastrointestinal obstruction or ischemia if the hernia becomes incarcerated.

Diagnosis and Tests

Hiatal hernias are typically diagnosed using imaging studies such as:

• Chest X-ray.
• Esophagram (video X-ray of the esophagus).
• Upper endoscopy (direct visualization of the esophagus and stomach).
• Esophageal manometry (pressure measurements in the esophagus).

Management and Treatment

Treatment Options: Treatment depends on the severity of symptoms. Options include:

• Watchful waiting: If asymptomatic, no immediate treatment may be necessary.
• Medications: Acid-reducing medications like proton pump inhibitors (PPIs) can alleviate symptoms and prevent damage.
• Surgery: Surgical repair (fundoplication) may be considered for severe cases or when medications are ineffective.

Outlook and Recovery

Recovery from hiatal hernia surgery varies but often involves a brief hospital stay followed by a period of restricted diet and a gradual return to normal activities. Surgery has a high success rate in resolving symptoms, although hernias can sometimes recur over time.

Living with a Hiatal Hernia

Managing a hiatal hernia at home involves:

• Using over-the-counter antacids sparingly for acid flare-ups.
• Adopting lifestyle changes such as weight loss, smaller meals, reduced fat intake, and avoiding late-night eating.
• Elevating the head during sleep and quitting smoking to reduce symptoms.

For expert consultation and personalized treatment options for hiatal hernias, contact Dr. Santhosh R, a distinguished Gastrointestinal, Advanced Laparoscopic, and Robotic Surgeon specialising in gastrointestinal disorders in Nagasandra, Bengaluru.

Conclusion

Understanding the types, symptoms, and potential complications of hiatal hernias empowers individuals to seek timely diagnosis and appropriate treatment. Effective management, whether through lifestyle adjustments, medications, or surgical intervention, can significantly improve quality of life and prevent long-term complications associated with this common condition.