Hiatus Hernia is the herniation of a part of the stomach into the thoracic cavity through the esophageal opening within the diaphragm. Hiatus hernia occurs at the oesophageal opening. The disease is common after middle age. It is estimated that about half the people above 60 years of age suffer from it, although most of them may not have any symptoms. The correct diagnosis of haitus hernia can be arrived at by means of berium meal x-ray test. Normally, the opening, or hiatus, is fairly tight and grips the esophagus just above the stomach. If oesophagitis is severe however, there may be pain on swallowing and eventually difficulty swallowing as the oesophagus becomes scarred and narrowed. Oesophagitis can cause bleeding but this is not usually severe. Although hiatal hernias are occasionally seen in infants where they probably have been present from birth, most hiatal hernias in adults are believed to have developed over many years
Hiatal hernia repair is surgery to correct a defect in the diaphragm, the breathing muscle that separates the chest area from the stomach area. Normally, the esophagus (food pipe) goes through the hiatus and attaches to the stomach. In individuals with hiatal hernias, the opening of the esophageal hiatus (hiatal opening) is larger than normal, and a portion of the upper stomach slips up or passes (herniates) through the hiatus and into the chest. The esophagus and stomach stay in their normal locations, but part of the stomach squeezes through the hiatus, landing it next to the esophagus The hernia itself is not dangerous in any way but once it has formed the mechanisms which normally prevent stomach contents from regurgitating into the gullet (oesophagus) are less effective. It is important to appreciate that it is not the hernia itself which gives rise to symptoms and it is for this reason that the term gastro-oesophageal reflux disease (GORD) is often used for those patients who have symptoms. Although there appears to be a link, one condition does not seem to cause the other, because many people have a hiatal hernia without having GERD, and others have without having a hiatal hernia. It runs through the chest, behind the lungs and heart, through the tight esophageal hiatus in the diaphragm to enter the stomach.
A diagnosis of hiatus hernia is fairly common. People blame this hernia for much more than it ever does. Patients with a hiatus hernia need to understand what it is and what might occur with it. Although hiatal hernias are present in approximately 15% of the population, they are associated with symptoms in only a minority of those afflicted. In a sliding hiatal hernia, the stomach and the section of the esophagus that joins the stomach slide up into the chest through the hiatus. A hiatus hernia is very common and for many individuals does not give rise to any problems at all. There are different types of hiatus hernia but the commonest is called a ‘sliding' hiatus hernia. Normally, the opening, or hiatus, is fairly tight and grips the esophagus just above the stomach. At this point, the esophagus wall is thickened and the muscle at this site is contracted, forming what is called a "sphincter". Normally, the sphincter is in a closed position, except following a swallow, and this prevents food or acid in the stomach from refluxing back up the esophagus. The typical symptom caused by this regurgitation of food and acid from the stomach is discomfort behind the breast bone which is called heartburn. Heartburn occurs commonly after a large meal, when bending over or when lying flat. When this widening occurs, the lower esophagus is out of normal position and the upper part of the stomach may push up through the enlarged hiatus, producing a hiatus hernia. People with a hiatal hernia may experience chest pain that can easily be confused with the pain of a heart attack. That's why it's so important to undergo testing and get properly diagnosed.
Causes of Hiatus Hernia
The common Causes of Hiatus Hernia :
- Muscle weakening and loss of elasticity as people age is thought to predispose to hiatus hernia, based on the increasing prevalence in older people. With decreasing tissue elasticity, the gastric cardia may not return to its normal position below the diaphragmatic hiatus following a normal swallow.
- Some experts suspect that increased pressure in the abdomen from coughing, straining during bowel movements, pregnancy and delivery, or substantial weight gain may contribute to the development of a hiatal hernia.
- Anything that puts intense pressure on the abdomen including persistent or severe coughing or vomiting, straining while going to the bathroom, pregnancy or lifting heavy objects can contribute to hiatal hernias.
- Straining with constipation
- Obesity and smoking may be risk factors in adults.
- Because the muscle is weak, the hernia occurs during abdominal strain.
- Hiatus hernias are very common, especially in people over 50 years old. This can lead to the entry of gastric acid from the stomach into the esophagus.
Symptoms of Hiatus Hernia
Some are common Hiatus Hernia :
- Feeling of food sticking in the esophagus
- Throat irritation (frequent clearing of the throat)
- Chest pain
- Difficulty swallowing
- Bleeding from the stomach or esophagus
- Pain or discomfort in the stomach,chest, or esophagus (swallowing tube)
Treatment of Hiatus Hernia
- The treatment of GERD is beyond the scope of this article and is discussed in Gastroesophageal Reflux Disease .
- Neutralizing acid or inhibiting acid production
- The hernia is at risk for twisting, which could cut off the blood supply to part of the stomach and cause that part to die.
- Large hiatal hernias may cause iron deficiency anemia regardless of whether Cameron ulcers are present This anemia responds well to PPI therapy with surgery offering no clear advantage over medical therapy.
- Surgery is necessary for a strangulated hiatal hernia and very large hiatal hernias that cause severe gastroesophageal reflux.
- The laparoscope is like a tiny video camera that gives the surgeon a clear view of the abdominal area. Other small incisions are made to insert the surgical instruments used to pull the stomach back down into the abdomen and repair the weak muscle or make a smaller opening between the diaphragm and the esophagus.
- Some medicines effectively reduce the secretion of stomach acid, while others increase the muscle strength of the lower esophagus, thereby reducing acid reflux
- Other symptoms that may occur along with the hernia such as chest pain should be properly evaluated Symptoms of GERD should be treated.
- Medications that neutralize stomach acidity, or that strengthen the lower esophageal sphincter, may also be used if not cured by the medicines, surgery is advised.
Prevention tips for Hiatus Hernia Cure and Hiatal Hernia diet :
Certain remedies have been found highly beneficial in the treatment of Hiatus Hernia .
- The patient of hiatus hernia should observe certain precautions in their eating habits. The foremost amongst these is not to take water with meals, but half an hour before or one hour after a meal.This is the proper Hiatal Hernia diet for the patient of this disease. This helps the digestive process considerably and reduces the incidence of heart burn.
- Another important factor in the treatment of this disease is to take frequent small meals instead of three large ones.
Thorough mastication of foods is also essential, both to break up the food into small particles and to slow down the rate of intake.
- The diet of Hiatal Hernia patient should consist of seeds, nuts and whole cereal grains, vegetables and fruits, with emphasis on fresh fruits, raw or lightly cooked vegetables and sprouted seeds.This is the proper Hiatal Hernia diet for the patient of this disease. The foods which should be avoided are over-processed foods like white bread and sugar, cakes and biscuits, rice puddings and over cooked vegetables. At least 50 per cent of the diet should consist of fruits and vegetables, and the remaining 50 per cent of protein, carbohydrates and fat.
- Raw juices extracted from fresh fruits and vegetables are valuable in haitus hernia, and the patient should take these juices half an hour before each meal. Carrot juice is specially beneficial as it has a very restorative effect, and is rich in vitamin A and calcium. This is the proper Hiatal Hernia diet for the patient of this disease.It is an alkaline food which soothes the stomach. All juices should be diluted with water on a 50: 50 basis as they are concentrated.
- The hot drinks should always be allowed to cool a little before taking. Extremes in temperature, in both food and drink should be avoided, drinks should not be taken hurriedly, but sipped slowly. The patient should avoid condiments, pickles, strong tea, coffee, alcoholic beverages