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Surgical Conditions

Hiatus Hernia

Hiatus Hernia :: Achalasia

A hiatus hernia (also known as a hiatal hernia) occurs when a portion of the stomach slides or protrudes through a gap in the diaphragm (a thin muscle that separates the stomach from the chest) up into the chest cavity. A hernia is a bulge or protrusion of part of the body into another part of the body that would normally contain it.

There are 2 main types of hiatus hernia.

Sliding hiatus hernia: this is the most common type of hiatus hernia. It occurs when the junction between the oesophagus and the stomach and the upper part of the stomach protrude up through the oesophageal opening in the diaphragm into the chest cavity. The herniated portion of the stomach can slide back and forth, into and out of the chest.

Rolling hiatus hernia: this is sometimes called a para-oesophageal hiatus hernia by doctors. In this case, part of the stomach bulges into the chest out of the weakest part of the diaphragm, which is the oesophageal opening. The junction of the oesophagus and stomach stays down within the abdomen, and the top part of the stomach (the fundus) bulges up into the chest cavity. This type of hernia normally remains in one place, sitting next to the oesophagus, and does not move in or out when you swallow.

Symptoms

Most people are not troubled by their hiatus hernia, but if reflux of the acid contents of the stomach occurs (called gastro-oesophageal reflux), you get heartburn. This is a painful burning sensation in the chest, which can sometimes be felt in the throat. Sudden regurgitation of acid fluid into the mouth can occur, especially when you lie down or bend forward. These symptoms are a problem when you go to bed and can wake you up. Other symptoms include belching, pain on swallowing hot fluids and a feeling of food sticking in the oesophagus.

Treatment

Treatment is called for only when the hernia results in symptoms, such as persistent heartburn or difficulty in swallowing. Acid inflammation and ulceration of the lower oesophagus also require treatment.

General guidelines for treating heartburn and oesophagitis (inflammation of the oesophagus) are:

  1. Avoid (or use only in moderation) foods and substances that increase
    reflux of acid into the oesophagus, such as:
    • nicotine (cigarettes)
    • caffeine
    • chocolate
    • fatty foods
    • peppermint
    • alcohol
    • spearmint
  2. Eat smaller, more frequent meals and do not eat within 2-3 hours of bedtime.
  3. Avoid bending, stooping, abdominal exercises, tight belts, and girdles all of which increase abdominal pressure and cause reflux.
  4. If overweight, lose weight. Obesity also increases abdominal pressure.
  5. Prescription medications.
  6. Elevate the head of the bed 8 to 10 inches by putting pillows or a wedge under the upper part of the mattress. Gravity then helps keep stomach acid out of the esophagus while sleeping.

Other Treatments Drugs -- Some medicines effectively reduce the secretion of stomach acid, while others increase the muscle strength of the lower esophagus, thereby reducing acid reflux.

Surgery -- The complicated hiatus hernia requires surgery occasionally on an emergency basis. Surgery otherwise is reserved for those patients with complications that cannot be handled with medications. The mere presence of a hiatus hernia is not a reason for surgery.


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