Hiatal hernia

It important to point out that- hernias occur when one part of the body protrudes through a gap or opening into another part. Every patient should know that, although a hernia can develop almost anywhere, most of them happen in the abdominal area. These include hiatal hernias — also known as diaphragmatic hernias, inguinal hernias, umbilical hernias and other… Good thing is that most of these small hiatal hernias don't cause any problems. That’s why –the fact is that patients could never know they have one unless doctor discovers it when checking for some other condition. Problem is that a large hiatal hernia can allow food and acid to back up into your esophagus, leading to heartburn and chest pain. If we talk about the treatment – then we should know that medications can usually alleviate these symptoms, although very large hiatal hernias sometimes need surgical repair.

If we are talking about hiatal hernia, then we should know that it is a condition in which the upper portion of the stomach protrudes into the chest cavity through an opening of the diaphragm called the esophageal hiatus. What's important to know is that this opening usually is large enough to accommodate the esophagus alone but in cases of extreme weakening and enlargement of the hiatus- it can allow passage in a wrong direction or even entrapment of the upper stomach above the diaphragm. Several researches done in the past have confirmed that hiatal hernia is a very common condition because -by age 60, up to 60% of people have it to some degree.

It is important to know that there are 2 types of hiatal hernia:

Every patient should know that, as its name implies, the sliding type of hiatal hernia occurs when the junction between the stomach and esophagus slides up through the esophageal hiatus. Researchers are saying that this mostly happens during moments of increased pressure in the abdominal cavity.  

Unlike the previous type- the fixed type of hiatal hernia implies that there is no sliding up and down. This is the worse scenario because a portion of the stomach remains stuck in the chest cavity all the time!

Although most of the people already know this- it is important to know that chest cavity and abdomen are separated by one muscle organ called the diaphragm. This is one large dome-shaped organ which is responsible for a normal breathing. Esophagus or food pipe passes into stomach logically- through an opening in the diaphragm. Well, these hiatal hernias occur when the muscle tissue surrounding this opening becomes weak and the upper part of stomach bulges through the diaphragm into chest cavity. In generally- there is one rule - anything that puts intense pressure on abdomen can contribute to hiatal hernias. Example of increased pressure situations are:

Several researches done in the past have proven that hiatal hernia can cause or contribute to gastroesophageal reflux. How come? Well, experts are saying that this happens when a hernia slightly displaces the lower esophageal sphincter. This sphincter is nothing more then a circular band of muscle around the bottom of the esophagus. Normally- the diaphragm is aligned with the lower esophageal sphincter, which is the extremely important because that’s how- it relaxes to allow food and liquid to flow into your stomach during swallowing. When this happens- the diaphragm supports and puts pressure on the sphincter to keep it closed when you're not swallowing. What happens during hernia? Well, hiatal hernia raises the sphincter above the diaphragm, reducing pressure on the valve which causes the sphincter muscle to open at the wrong time, allowing stomach acid to flow up into the esophagus.  

It is important to know that, in most cases- a hiatal hernia by itself causes no symptoms. Other people may experience:

Other causes of hiatal hernia symptoms

Some researches have proven that, only in some cases- in case of a fixed hiatal hernia, the blood supply is cut off to the trapped portion of the stomach, causing serious pain and condition. This condition is called a strangulated hiatal hernia, and it represents a real medical emergency.

Like it was been already told- hiatal hernia also causes symptoms of discomfort when it is associated with a condition called gastroesophageal reflux disease. The main characteristic of this condition is upwelling of stomach acids and digestive enzymes into the esophagus through a weakened sphincter. Some patients have also noted that hiatal hernia or GERD can cause chest pain similar to angina including chest pressure that can radiate to the arm or neck- that’s also true! That’s why- when in doubt, it is safer to be seen by a doctor immediately in order to rule out more serious problems first.

Because, it is often confused with heartburn- in most cases doctor may discover a hiatal hernia while trying to determine the cause of heartburn or chest or upper abdominal pain. Anyway, there are several diagnostic methods which have the potential to discover this medical problem!

Every patient should know that during this diagnostic test, patient drinks one liquid containing barium that coats upper digestive tract. Why is this being done? Well, it is simple- it provides a clear silhouette of your esophagus on an X-ray.  

Everyone knows that, in this test doctor passes a thin, flexible tube with a fiber-optic light and video camera system down the patient’s throat to check for inflammation.  

Every patient should know that some large hiatal hernias create lesions in the upper stomach which can sometimes bleed and lead to iron deficiency anemia from chronic blood loss. In some cases- the part of the stomach that protrudes into the chest cavity becomes twisted or cuts off blood flow to the rest of the stomach, producing severe chest pain and difficulty swallowing. The most common complication of hiatal hernia is probably gastroesophageal reflux disease (GERD). Recurrent GERD itself can lead to complications, including:

Logically- when stomach acid is backing up into esophagus – it can lead to serious inflammation and scarring. It can also narrow esophagus, making it hard for a patient to swallow.

Only in some cases- people with gastroesophageal reflux develop Barrett's esophagus-condition which occurs from repeated, long-term exposure to stomach acid. Every patient should know that, in this condition, cells similar to those in the stomach lining develop in the lower esophagus which represents a great risk for developing esophageal cancer.  

Unfortunately -some people with Barrett's esophagus develop esophageal cancer and, in most cases-the prognosis is often poor. This is because an esophageal tumor makes swallowing increasingly difficult and for some people, eventually impossible.

Bad thing is that most of the patients which don’t have any symptoms believe that they don’t need any kind of treatment! But there is a risk that person could experience recurrent gastroesophageal reflux, which sometimes could be dangerous- but it is treatable!

It is proven that some over-the-counter antacids can neutralize the acidity in esophagus and provide relief from heartburn.  

Every patient should know that these medications reduce the amount of acid secreted by stomach by blocking histamine receptors. Some of the most commonly used include famotidine (Pepcid), cimetidine (Tagamet), ranitidine (Zantac) and nizatidine (Axid). Some patients may experience some side effects, such as bowel changes, dry mouth, dizziness or drowsiness.  

These drugs are the most effective drugs for the treatment of GERD because they block acid production and allow time for damaged esophageal tissue to heal. Some of the most commonly used are lansoprazole (Prevacid), pantoprazole (Protonix), rabeprazole (Aciphex), omeprazole (Prilosec) and esomeprazole (Nexium). 

Good thing is that only few people with a hiatal hernia may need surgery because it is usually considered only when medications and lifestyle changes fail to relieve severe reflux symptoms.

What is so important to know about this operation? Well, it may involve pulling stomach down into your abdomen and making the opening in your diaphragm smaller. In some cases this is done using a single incision in your chest wall or abdomen. In other cases, surgeon may insert instruments and a fiber-optic camera through several small incisions in your abdomen. The operation is then called the laparoscopic surgery.