Hiatal Hernia: Causes, Symptoms, and Treatment

Overview

What is Hiatal Hernia?

Hiatal hernia is when the top portion of the stomach bulges out through the diaphragm opening, called hiatus, into the chest area. Hiatal hernia can happen at any age or to any gender. Occasionally, Hiatal hernia does not cause any problems and also does not require treatment. But in some cases, the stomach contents return to the esophagus causing various symptoms, including heartburn.

One can effectively treat mild symptoms with self-care and medications, but severe symptoms might require surgery to resolve the issue.

Prevalence

• The Hiatal hernia incidence increases with age, and around 60% of individuals over 50 might have a Hiatal hernia.
• Hiatal hernia is more prevalent in Western Europe and North America but rare in African communities.
• Although Hiatal hernia is common, only 10% of the affected individuals experience noticeable symptoms ¹Overview| Researched based study from Sciencedirect.com

Types

Types of Hiatal Hernia

The two main types of Hiatal hernia are as follows:

• Fixed Hiatal hernia
• Sliding Hiatal hernia

Fixed Hiatal Hernia

• In a fixed Hiatal hernia, the stomach’s upper part pushes through the diaphragm and remains there. In most cases, it is not severe, but there is a risk that the stomach’s blood flow could get blocked, leading to severe damage and medical urgency.
• The condition is rare and is known as a paraoesophageal hernia.

Sliding Hiatal Hernia

• Sliding Hiatal hernia is the most frequent type and occurs when the esophagus and the stomach slide into and protrude out of the chest area through the hiatus.
• The condition usually does not cause symptoms and may resolve without treatment ²Types| Researched based study from Nlm.nih.gov

Symptoms

Symptoms of Hiatal Hernia

Most people with Hiatal hernias, including fixed Hiatal hernias, don’t notice any symptoms. However, some might experience the following symptoms:

• Heartburn that worsens when one lies down or lean
• Chest pain
• Difficulty swallowing
• Acid reflux (stomach acid flows back into the esophagus)
• Backflow of food and liquid into the mouth
• Burping (expelling gas through the mouth)
• Stomach gas (bloating)
• Upset stomach
• Nausea and vomiting
• Shortness of breath
• Unpleasant taste in the mouth
• Passing black stool ³Symptoms| Researched based study from Nlm.nih.gov

Causes

Causes of Hiatal Hernia

The exact cause that leads to structural weaknesses causing Hiatal hernia is unclear to date.

However, the most probable cause of Hiatal hernia are:

• Damage or injury that weakens the muscle tissue
• Repeated excess pressure on the stomach muscles during vomiting, coughing, lifting heavy loads, and straining during bowel movements
• Physical strenuous exercise that puts pressure on the abdomen
• Changes in the diaphragm with age
• Unusually huge diaphragm at birth( in rare cases)
• Extra fluid buildup in the abdomen ⁴Causes| Researched based study from Nlm.nih.gov

Diagnosis

Diagnosis of Hiatal Hernia

To diagnose a Hiatal hernia, the doctor might perform the following test:

Barium swallow test

• It is an imaging test to check problems in the esophagus, stomach, throat, and parts of the small intestine.
• The test involves drinking the barium liquid followed by an X-ray. It gives the doctor a complete picture of the stomach disorders, tumors, and ulcers in the esophagus.

Endoscopy

• The doctor inserts a thin long tube called the endoscope into the throat.
• The camera attached to the tube lets the doctor get a clear picture of the esophagus and the stomach.

Esophageal manometry

• Esophageal manometry checks the proper working of the esophagus
• During the test, the doctor inserts a pressure-sensitive tube through the nose into the esophagus and stomach.
• It evaluates the coordinated muscle movement of the esophagus

pH test

• The pH test measures the acid levels in the esophagus from the stomach during 24 hour period.
• It is performed to evaluate the effectiveness of heartburn treatment

Gastric emptying test

• The gastric emptying test is a test to determine how quickly the food leaves the stomach.
• It determines if the stomach muscles are working properly
• It is recommended for patients with frequent vomiting and abdominal pain to determine other causes besides Hiatal hernia ⁵Diagnosis| Researched based study from Nlm.nih.gov

Risk factors

Risk factors of Hiatal Hernia

The risk factors that weaken the diaphragm’s opening through which the esophagus (food pipe) passes are as follows:

• Increased weight (Obesity)
• Advanced age (50 years and above)
• Smoking
• Certain surgical operations involving the food pipe
• Genetic factors leading to a congenital anomaly in the diaphragm ⁶Risk factors| Researched based study from Nlm.nih.gov

Complications

Complications of Hiatal Hernia

GERD

• In some cases, Hiatal hernia can lead to GERD (Gastroesophageal reflux disease). It is a persistent condition when the stomach acids leak back into the esophagus.

Lung infections such as pneumonia

• It occurs when stomach content moves up to the lungs

Strangulated hernia

• A strangulated hernia is when the stomach is squeezed tightly, and the blood supply is cut off.
• It is a fatal condition and needs prompt medical attention.

Iron deficiency anemia

• Iron deficiency anemia is when blood lacks adequate healthy red blood cells.
• It occurs in case of large hernia ⁷Complications| Researched based study from Nlm.nih.gov

Treatment

Treatment of Hiatal Hernia

Most Hiatal hernia does not require treatment. The presence of heartburn symptoms is treated with medications. If medication does not work, surgery is recommended in some cases.

Medications

Over-the-counter antacid (neutralizes stomach acid)

• Pantoprazole
• Rabeprazole
• Esomeprazole

Proton pump inhibitors (prevent acid production)

• Lansoprazole
• Omeprazole

H2-receptor blockers (lowers acid production)

• Cimetidine
• Nizatidine
• Famotidine

Surgery

Hiatus repair surgery

• It is done by tugging the stomach to move into the abdomen and making the diaphragm opening smaller.
• The procedure might also restructure the esophageal sphincter and eliminate the hernial sacs.

Collis Nissen gastroplasty

• It is a surgical procedure to lengthen the esophagus in severe Hiatal hernia cases in which the esophagus has shortened.
• In the operation, the surgeon uses tissues from the upper part of the stomach to extend the esophagus.

Nissen Fundoplication

• The surgery tightens by stitching the upper part of the stomach, i.e., the fundus, with the bottom portion of the esophagus to hold the stomach in place below the diaphragmatic hiatus.
• The stitches create pressure at the esophagus end and prevent acid reflux ⁸Treatment| Researched based study from Nlm.nih.gov

Lifestyle modification tips for Hiatal Hernia

• Regular exercise to manage weight
• Managing stress by taking regular relaxing walks and practicing yoga
• Drinking plenty of water and staying hydrated
• Keeping a note of the triggered acidic foods and avoiding them
• Eating slowly and drinking plenty of water with meals
• Eating enough fiber foods
• Avoiding eating before exercise
• Wearing loose- fitting comfortable clothing
• Taking probiotics(live beneficial bacteria in some supplements and foods)
• Using a small amount of healthy cooking oils such as olive oil, coconut oil
• Avoiding fasting as well as overeating
• Eating only whole foods instead of refined foods
• Drinking a small quantity of diluted apple cider vinegar before meals ⁹Treatment| Researched based study from Nlm.nih.gov

Seek medical attention if one with a Hiatal hernia has the following symptoms:

• Severe pain in the chest and belly
• Vomiting
• Can’t pass gas and can’t defecate
• Long-term upset stomach ¹¹Treatment| Researched based study from Nlm.nih.gov

Prevention

Prevention of Hiatal Hernia

It is quite difficult to prevent a Hiatal hernia. However, some of the ways to reduce the risk and minimize the symptoms are as follows:

• Losing excess weight
• Eating meals in small sizes several times instead of one big meal
• Avoiding straining during bowel movements
• Avoiding certain abdominal exercises
• Avoiding tight belts
• No to acidic foods
• No to alcohol and caffeine
• Avoiding smoking
• Limiting intake of fried and fatty foods
• Avoiding sleeping just after meals and waiting for at least three to four hours before lying down
• Keeping the head in an elevated position during sleep¹⁰Prevention| Researched based study from Nlm.nih.gov

Food to avoid for Hiatal Hernia

Avoiding certain foods might reduce some of the symptoms of Hiatal hernia, such as stomach gas (bloating), heartburn, and acid reflux. Some foods to avoid are listed below:

• Fatty food
• Salty foods
• Spicy food
• Processed food
• Red meat
• Garlic
• Onions
• Cucumbers
• Tomatoes
• Citrus fruits
• Chocolate
• High-fat dairy products
• Sweetened juices
• Bread and cereals
• Mint products such as candies and peppermint
• Caffeine
• Alcohol
• Soft drinks and carbonated beverages ¹²Prevention| Researched based study from Nlm.nih.gov

Takeaway

Key Takeaways

• Hiatal hernia is a common disease in which the stomach bulges through the diaphragm.
• Hiatal hernia symptoms are rare, with only some experiencing heartburn and acid reflux.
• Most Hiatal hernia risk factors, such as genetic factors, are unavoidable
• Obesity and lifestyle modification can well manage Hiatal hernia
• Doctors might recommend surgery in severe cases of Hiatal hernia