HIATUS HERNIA

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Facts on Hiatal Hernia

Definition of Hiatal Hernia

Let us get into the basics of what is what. What do you understand by the term ‘Hiatal Hernia?’

The answer is quite simple. A Hiatal Hernia occurs, when the upper portion of your stomach, pushes its way, across your diaphragm and into your chest region. The diaphragm is a large muscles between your abdomen and chest. It is the muscle, which helps you breathe. But if you are diagnosed with a hiatal hernia, a portion of your stomach, pushes its way, through this particular muscle namely the diaphragm. The opening it moves through, is known as the hiatus.

Hiatus Hernia

Small hernias may not always cause symptoms while large hiatal hernias can cause symptoms of heart burn.

Causes for the occurrence of a Hiatal Hernia

Although the exact cause, for formation of a Hiatal Hernia is unknown, it is excessive pressure you put on your abdominal muscles that cause the stomach push its way, through the hiatus. The major causes, for a Hiatal Hernia are excess intra abdominal pressure due to

  • Prolonged and excessive coughing
  • Vomiting
  • Strained bowel movements or
  • Lifting heavy objects

And the major risk factors that can trigger a hiatal hernia are

  • Smoking
  • Obesity and
  • Ageing

Types of Hernias

Basically, you find that there are two different types of Hiatal Hernias. These are

  • Sliding Hiatal Hernia and
  • Para-esophageal Hernia

Sliding Hiatal Hernia

A sliding hiatal hernia is a more common type of a hiatal hernia. In this particular case, your stomach and your esophagus slide in and out of your chest, via the hiatus. Sliding hernias do not cause serious symptoms except heart burn.

Para-esophageal Hernia

In a fixed Hiatal Hernia, a portion of your stomach pushes its way through the diaphragm and stays there. Although there are not many risk factors, connected with this type of hernia, sometimes the blood flow to the stomach can severely get blocked. This is a serious damage and is considered a medical emergency.

Common symptoms associated with a Hiatal Hernia

The symptoms include

  • Heartburn

  • Belching

  • Difficulty swallowing

  • Chest or abdominal pain

  • Feeling especially full after meals

  • Vomiting blood or passing black stools, which may indicate gastrointestinal bleeding

Diagnosis of Hiatal Hernia

Barium X-Rays

During this procedure, you drink a chalky liquid containing barium that coats your esophagus and stomach. You are asked to drink the liquid and X rays are taken immediately while you lie down. This provides a clear picture of your esophagus, stomach and the upper part of your small intestine (duodenum).

Endoscopy

In an endoscopy, the doctor passes a lighted thin flexible tube with a video camera, fitted at the rear end, through your throat. The doctor can clearly view the degree of hernia. He can also see the inner most lining of the esophagus. Presence of esophagitis, ulcers or Barrett’s esophagus can be detected this way.

Treatment of Hiatal Hernia

Symptoms of hiatal hernias can be treated with over the counter drugs that help neutralize the acid formation in your stomach. These include

  • Antacids that neutralize acid production
  • H2 receptor blockers, to help lower down acid production and
  • Proton pump inhibitors, that can arrest acid production all together, giving your esophagus ample time to heal.

Surgery

Life style changes - One would need to avoid factors that promote reflux, like avoiding spicy and fatty foods and lying down with head end of bed raised or using extra pillows.

If medical treatment and life style changes don’t work out, surgery is the best and definite treatment of this problem.

Laparoscopic Nissen’s fundoplication – It is the gold standard procedure and is performed by laparoscopy (key hole surgery) in most centers. It involves repairing the wide diaphragmatic opening and strengthening the lower esophageal sphincter by wrapping the upper end of stomach around the lower end of esophagus. This would prevent herniation of the stomach upwards and prevent reflux and relieve your symptoms.

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