Hiatus Hernia


What is Hiatus Hernia?

Hiatus Hernia is a condition in which the upper part of stomach bulges or squeezes through the opening in diaphragm (large muscle separating chest and abdomen). Diaphragm has a slight natural opening (hiatus) that acts as a path for oesophagus which allows the food to enter the stomach. However, when stomach gets pushed through diaphragm in the chest, hiatus hernia develops.

Causes of Hiatus Hernia

  • Congenitally large hiatus
  • Injury to the area
  • Immense and continuous pressure while vomiting, straining during bowel movement, lifting heavy objects and chronic coughing
  • Advanced age – because at such an age the diaphragm muscle weakens
  • Indigestion or dyspepsia

Symptoms of Hiatus Hernia

  • Acid reflux symptoms
  • Heart burn: a burning feeling emerges from the abdomen or upper stomach to the lower chest area and into the neck
  • Pain in upper abdomen and chest
  • Acidic taste in the mouth
  • Feeling bloated in the stomach
  • Excessive belching
  • Unable to swallow hot drinks due to burning pain in the stomach
  • Persistent coughing at night due to reflux acid irritating the trachea
  • Asthma symptoms
  • Gum problems and bad breath
  • Hoarseness
  • Feeling of lump in the throat
  • Severe chest pain

Diagnosis of Hiatus Hernia

Diagnosis is usually by upper GI Endoscopy. In this the endoscopist passes a flexible tube with camera and light (endoscope) down the throat and visualizes the inside of oesophagus and stomach. Other tests are contrast x-ray of upper digestive system (Barium Meal) – wherein contrast coating allows the radiologist to identify silhouette of stomach protruding in the chest and oesophageal manometry and 24-hour pH study.

Treatment of Hiatus Hernia

If patient with hiatus hernia does not have any symptoms, they will not need any treatment. However, if the hernia is large or if patient is experiencing recurrent heartburn, acid reflux or breathing discomfort, treatment is needed.

  • Lifestyle modification is the first step advised and may help control the symptoms. It includes – eating small frequent meals, avoiding fatty/fried/spicy foods, eating at least 2 hours before bedtime, and elevate the head end of bed by up to 6 inches. Patient is also advised to maintain a healthy weight and to quit smoking.
  • Medications that block acid production and heal the oesophagus (proton pump inhibitors etc) are highly effective and are to be used as second line of treatment.
  • Surgery is required for patients with large hiatus hernia and persistent severe symptoms even after lifestyle modifications. In selective cases it may be advised to young people responding well to medicines, to avoid lifelong medications.
  • Surgery is done laparoscopically by small punctures on the abdominal wall and involves pulling down the herniated stomach back in the abdomen and making the abnormally large opening in the diaphragm smaller to prevent future recurrent herniation. The upper part of the stomach is wrapped around the oesophagus and sutured in place so that it forms a barrier to the backflow of acid and stomach juices.
  • Laparoscopic or robotic approach results in smaller wounds, less pain, faster recovery, and early return to normal activities.