Hiatus Hernia

 

Introduction?

A hiatus hernia is where part of the stomach pushes up in to the lower chest through a defect in the diaphragm.  The diaphragm is a large flat muscle whose main function is to help with breathing. It is a large muscle that separates the lungs from the abdomen. The gullet (also called oesophagus) normally comes through a hole (hiatus) in the diaphragm, the muscle fibres in the diaphragm around the lower oesophagus helps stop acid from the stomach refluxing in to the gullet. A hiatus hernia occurs when some of the stomach pushes through this hole.

Most people with a hiatus hernia do not have any symptoms or problems; however, having a hiatus hernia can make you more prone to developing acid reflux (also called Gastro-oesophageal reflux disease). This usually presents with symptoms or heartburn.

How is a hiatus hernia diagnosed?

It can be diagnosed in a number of different ways. Endoscopy is the most common test, this is when a thin tube is passed from the mouth, down the gullet and in to the stomach. Another method is a barium swallow, which is when you swallow fluid which lines the gullet and x-rays are taken. This allows the doctor to see if there is a hiatus hernia. Finally an uncommon method is to have oesophageal manometry studies performed. This involves passing a thin tube through your nose and into the stomach, and this measures the pressure at various points in the oesophagus and can determine whether a hiatus hernia is present.

Treatment of a hiatus hernia?

If you have no symptoms from the hiatus hernia then you do not need any treatment, the hiatus hernia itself causes no harm.

If you have reflux symptoms then lifestyle changes: such as stopping smoking, reducing your alcohol intake and avoiding foods that make symptoms worse will help. If you are overweight then weight loss can sometimes improve symptoms from a hiatus hernia.  If you have acid reflux symptoms despite lifestyle changes, then medications to reduce acid secretion can help. There are two main types of medication, proton pump inhibitors (PPI) and H2-receptor antagonists. 

If symptoms are still troublesome despite acid suppression medication, or you are not keen to take long term medication in some cases surgery can be performed to improve symptoms. During this procedure the stomach is put back into the abdomen in its correct position and the area around the diaphragm where the oesophagus passes through is tightened.

 

Haitus Hernia