Hiatal Hernia

The diaphragm is a sheet of muscle located between chest and abdomen and helps in breathing. The esophagus that carries food and liquid to the stomach passes through an opening in this diaphragm. Normally this hole, called a hiatus, is small and fits snugly around the esophagus. The J-shaped stomach sits below the diaphragm.

In some people, the hiatus or hole in the diaphragm weakens and enlarges. It may be due to heredity, or caused by obesity, exercises such as weightlifting, or straining at stool. Whatever the cause, a portion of the stomach herniates, or moves up, into the chest cavity through this enlarged hole. Hiatus hernias are very common, occurring in up to 60 percent of people by age 60.

Sliding Hiatus Hernia is the most common type of hiatus hernia, where the herniated portion of the stomach slides back and forth, into and out of the chest. In other type (paraesophageal hernia) the dome part of the stomach herniates through the hiatus and causes pain, discomfort and even breathing difficulty.

In most patients, there are no symptoms of hiatal hernia. This is especially true of sliding hernias. When symptoms occur, they may only be heartburn and regurgitation, when stomach acid refluxes back into the esophagus. Pain from hiatal hernia is one of the major symptoms of condition. Gastroesophageal reflux disease is a commonly associated with hiatal hernia.

Diagnosis of a hiatus hernia is typically made through an upper GI barium x-ray. A complementary test is upper-intestinal endoscopy, in which the physician visually examines the esophagus and stomach using a flexible scope while the patient is lightly sedated.

Treatment

Treatment for hiatal hernia is needed for only when the hernia results in symptoms, such as persistent heartburn or difficulty in swallowing. Acid inflammation and ulceration of the lower esophagus also require treatment. Please refer to the GERD section also for detailed treatment. Surgery is reserved for those patients with complications that cannot be handled with medications and in case of paraesophageal hernia. The mere presence of a hiatus hernia is not a reason for surgical hiatal hernia treatment.

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