Hiatal Hernia


WHAT IS HIATAL HERNIA?

 A hiatal hernia occurs when the upper portion of the stomach bulges through the diaphragm, the muscle that separates the abdomen and chest.

A small, minor hiatal hernia isn’t typically a cause for concern, often going unnoticed unless a doctor discovers it while checking for another condition. Large hiatal hernias, however, may allow food and stomach acid into the esophagus – a major cause of heartburn. Lifestyle changes or medication can help alleviate symptoms, but in more severe cases, surgery may be necessary. 

If you’re experiencing GI symptoms, schedule an appointment with your gastroenterologist today. 

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hiatal hernia, before hiatal hernia and after hiatal hernia diagram

CAUSES

 If weakened muscle tissue allows your stomach to push through your diaphragm, a hiatal hernia is the result. The cause of this GI condition is not always clear, but may occur due to the following: 

  • Age-related diaphragm changes
  • Injury to the area (trauma, surgery complications, etc.)  
  • Being born with an unusually large hiatus
  • Persistent and severe pressure on surrounding muscles (while coughing, vomiting, straining when passing a bowel movement, exercising, etc.)

RISK FACTORS 

The following groups face a higher risk of developing a hiatal hernia:

  • People aged 50 or older
  • Obese individuals
  • Women 

SYMPTOMS

Many patients don’t experience any symptoms at all, but for those who do, the most common are related to chronic acid reflux, also known as gastroesophageal reflux disease, or GERD. Symptoms include:

  • Heartburn (burning sensation in the chest, especially after eating)
  • Non-cardiac chest pain (recurring chest pain that feels similar to angina)
  • Indigestion (sensation of fullness soon after eating with a burning type of abdominal pain)
  • Burping and regurgitation (food, gas and acid rising back up into the throat)
  • Trouble swallowing (feeling of a lump in your throat when you swallow)
  • Sore throat or hoarseness (aching in mouth while talking)

Keep in mind that not everyone with a hiatal hernia experiences acid reflux – and every case of acid reflux is not necessarily related to a hiatal hernia. But if these symptoms are occurring more often, they might be related. Visit your local GI specialist to determine the cause of your symptoms. 

Other possible warning signs of a hiatal hernia might include:

  • Nausea (due to compression of your stomach or acid overflow, or both)
  • Shortness of breath (if the hernia causes lung compression)
  • Upper abdominal or lower chest pressure/pain 
  • Bloody vomit or black stools (due to gastrointestinal bleeding)  

TYPES OF HIATAL HERNIA

There are two main types: sliding hiatal hernias and paraoesophageal hiatal hernias. The sliding variety, Type 1, is most common. Paraoesophageal (meaning “beside the esophagus”) hernias are divided into three types. Our Charleston GI physicians are equipped to diagnose and treat the following:

  • Type 1: Also called a sliding hiatal hernia, Type 1 hernias account for 95% of all hiatal hernias. In these cases, the part of the esophagus that connects to the stomach slides through the widened hiatus at times and then slides back down.
  • Type 2: In these instances, the upper part of the stomach protrudes through the hiatus alongside the esophagus, forming a bulge. This is also called a rolling hiatal hernia.
  • Type 3: A mix of Type 1 and 2, this variety results when the part of the esophagus that connects to the stomach — the gastroesophageal junction — slides up through the hiatus at times. Another part of your stomach then bulges through, alongside the gastroesophageal junction.
  • Type 4: Type 4 is the rarest, and also the most complicated. For patients with Type 4, the hiatus is wide enough for two different organs to bulge through, like the pancreas, spleen, or one of the intestines.

COMPLICATIONS

 The most common problem that results from a hiatal hernia is chronic acid reflux. This GI condition can cause esophageal damage over time if not properly managed with medication.

Complications of chronic acid reflux can include:

  • Esophagitis (acid in the esophagus causes inflammation of its lining, causing pain, swallowing problems, ulcers, and even bleeding)
  • Esophageal stricture (chronic inflammation causes esophageal scarring, with scar tissue impacting swallowing muscles and resulting in a narrowed esophagus)
  • Barrett’s esophagus (chronic inflammation that eventually leads to tissue changes and is considered precancerous)  

In more rare instances, hiatal hernia may cause these serious complications if it gets stuck or compressed in the hiatus: 

  • Gastrointestinal obstruction (stomach or another organ could get stuck and compressed or twisted in the hiatus, creating a blockage in the GI tract)  
  • Gastritis (trapped acid in the herniated part of your stomach causes inflammation, stomach ulcers and bleeding)
  • Ischemia (hernia becomes so tightly compressed that it cuts off its own blood supply, potentially leading to tissue death)

WHEN TO SEE A DOCTOR

If you are experiencing these hiatal hernia symptoms, schedule an appointment with a board-certified gastroenterologist at Charleston GI today. Our team is here to help, committed to providing a higher standard of caring – and much-needed relief. No referral needed!

DIAGNOSTIC TEST 

  • Upper endoscopy: An upper endoscopy goes inside your esophagus and stomach with a tiny camera on the end of a long tube. It projects live images onto a screen.
  • Chest x-ray: A chest X-ray or radiography uses radiation to take still, black-and-white images of the inside of your chest cavity, where your esophagus lies.
  • Esophagram: An esophagram is a sort of video X-ray of your esophagus in action. It takes real-time video of the inside of your esophagus when you swallow.
  • Esophageal manometry: This test uses a catheter inside your esophagus to take pressure measurements of the muscles. It converts the data into a topographical pressure map.

TREATMENT

Your GI physician may recommend one of the following to relieve symptoms:

  • Regular physical examinations to monitor the hernia over time.
  • Medication
  • Surgery

PREVENTION

Routine medical exams are key to prevention. In addition to regular visits to your GI specialists, consider the following to manage reflux symptoms and promote overall health:

  • Maintain a healthy BMI. 
  • Eat smaller meals.
  • Consume less fat.
  • Avoid lying down for a few hours after eating. 
  • Keep your head elevated while sleeping. 
  • Quit smoking.
  • Take over-the-counter medication, like antacids. 

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FREQUENTLY ASKED QUESTIONS

What is hiatal hernia pain like?

A hiatal hernia is found where your abdomen and chest meet, so you may experience chest pain or abdominal pain. If the hernia gets compressed or pinched during certain activities (bending over, coughing, etc.), pain may worsen. 

In most cases, symptoms are related to acid reflux instead of the hernia itself. When acid irritates your esophagus, a burning sensation may radiate throughout the chest. In severe cases, it may even mimic the pain experienced during a heart attack. When in doubt, seek medical attention immediately.

Why are hiatal hernias common in women?

Despite extensive research, the exact cause remains a mystery. Because weakened supporting tissue may be to blame, older individuals, smokers, obese people, or pregnant women face an increased risk. 

Do hiatal hernias go away on their own?

No. In fact, hernias typically worsen over time if left untreated. If your hiatal hernia never causes any symptoms, it may not require treatment. But if it does, symptoms will likely continue or even get worse. Mild acid reflux can often be managed with medication but may require surgery if it becomes severe.

How common are hiatal hernias?

Hiatal hernias are common, especially in the aging population. affecting about 20% of all Americans. Hernias impact 50% of people over age 50, 60% over age 60, and 70% over age 70.

How serious is a hiatal hernia?

Most aren’t serious and don’t cause symptoms. You may never know that you have one! Larger hernias may cause complications and often cause symptoms.

What is the main cause of hiatal hernia?

The exact cause of hiatal hernia is unknown but may be related to weakness of the supporting tissue. That’s why the risk of hernias increases with age, obesity, and smoking.

Can a hiatal hernia be cured?

Acid reflux symptoms due to a hiatus hernia can often be managed with lifestyle changes and medication. Some sufferers may need ongoing maintenance therapy with a proton pump inhibitor. 

What are common symptoms of hiatal hernia?

Most small hiatal hernias cause no symptoms at ll. But larger hiatal hernias can cause:

  • Heartburn
  • Regurgitation of food or liquids into the mouth 
  • Backflow of stomach acid into the esophagus (acid reflux)
  • Difficulty swallowing
  • Chest or abdominal pain
  • Feeling full soon after you eat
  • Shortness of breath
  • Vomiting of blood or passing of black stools (an indication of GI bleeding)

How does a hiatal hernia cause acid reflux?

When the gastroesophageal junction, the place where the esophagus and stomach meet, rises above your diaphragm, it pulls on the muscles that would normally contract to prevent acid from rising back up into the esophagus. When these muscles don’t function properly, stomach acid can wash back up. The hernia may also trap a pocket of acid at the top of the stomach that doesn’t clear away.

What are signs that a hiatal hernia is getting worse?

Heartburn, regurgitation, belching, hiccupping shortly after eating, or a stinging sensation in the throat may all indicate that your hiatal hernia is becoming more severe.

How effective is surgery for a hiatal hernia?

Studies show that hiatal hernia surgery has a 90% success rate, with most patients able to stop medications and enjoy a symptom-free life. Follow-up appointments are recommended yearly.

In long-term studies, up to 50% of hiatal hernias return at some point post-surgery, usually after many years. This might indicate that part of the surgery failed or that the original cause of the hernia is still active. Keep in mind that not all recurring hernias present the same symptoms.

What is recovery from hiatal hernia surgery like?

Patients typically recover in the hospital for a day or two, depending on the hernia’s severity and the type of surgery performed. Because it is minimally invasive, laparoscopic surgery requires a shorter recovery time than open surgeries. 

Recovery continues at home for about two to six weeks, during which you will consume a very limited diet. Patients begin with clear liquids and gradually progress to soft foods, then solids. Weight loss after hiatal hernia surgery is common, with many people in recovery shedding about 10 to 15 pounds. 

What happens if I don't get hiatal hernia surgery?

Failure to get the surgery needed may result in digestive distress, ulcers, bleeding, and a marked decline in quality of life. 

What size hiatal hernia needs surgery?

There is no predetermined size when surgery is required. The decision is based on several factors, like the severity of symptoms, the presence of other medical conditions, and the preference of the patient.

What is the difference between acid reflux and hiatal hernia?

Hiatal hernia is a protrusion of gastrointestinal junction and stomach parts towards the diaphragm. Whereas GERD is a condition where the acidic contents of the stomach pass into the esophagus. This may be due to the reduced pressure on the lower esophageal sphincter muscle.

Can you have acid reflux without hiatal hernia?

Yes, sufferers may experience chronic reflux without a hiatal hernia. On the other hand, patients may have no pathologic reflux when a hiatal hernia occurs.

 


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