A hernia is a protrusion of part of an organ through the muscle wall that surrounds it. A hiatal hernia occurs when the upper part of the stomach pushes up into the chest through a small opening in the diaphragm, the muscle that separates the abdomen from the chest. A hiatal hernia results in retention of acid and other contents, since the stomach tends to get squeezed by this opening in the diaphragm. These acids and other substances can easily back up (reflux or regurgitate) into the esophagus.
There are four types of hiatal hernias. The vast majority of hiatal hernias are called a type I or sliding hiatal hernias. In this type, the stomach intermittently slides up into the chest through a small opening in the diaphragm. Types II, III, and IV hiatal hernias are called paraesophageal hernias. They happen when a portion of the stomach pushes up into the chest adjacent to the esophagus.
Most of the time, a hiatal hernia does not cause symptoms. Heartburn, belching, nausea, vomiting, and regurgitation - or backflow of stomach content into the esophagus or throat - are the most common symptoms. They can be present in all four types. More severe symptoms are usually associated with a paraesophageal hernia. Those signs and symptoms include:
- Intermittent difficulty swallowing, especially solid foods
- Feeling full after eating only a small amount of food
- Abdominal or chest pain
- Abdominal bleeding, which is apparent as bright red blood in vomit, as dark red or black stools, or as anemia, or blood loss, on a blood test
People with type IV paraesophageal hernias may have a significant portion of their stomach or other abdominal organs push up into their chest. In severe cases, the stomach or abdominal organs may rotate or twist, causing severe pain. This is a medical emergency and will likely require immediate surgery.
A doctor will perform a medical exam and medical history. A chest X-ray, upper endoscopy, barium swallow, or manometry, a test to measure the pressure in the esophagus, may be ordered to confirm the diagnosis.
Many people age 50 and over have small hiatal hernias; however, hiatal hernias may affect people of all ages.
The cause of a hiatal hernia is unknown, but possible triggers include the following:
- Straining while defecating (having a bowel movement)
- Sudden physical exertion
Obesity can also contribute to this disorder.
Specific treatment for hiatal hernia will be determined by your doctor based on:
- Your age, overall health, and medical history
- Extent of the condition
- Your tolerance for specific medications, procedures, or therapies
- Expectations for the course of the condition
- Your opinion or preference
Although hiatal hernias usually do not require treatment, treatment may be necessary if the hernia is:
- In danger of becoming strangulated (twisted in a way that cuts off blood supply to the stomach).
- Complicated by severe gastroesophageal reflux disease (GERD).
- Complicated by esophagitis (inflammation of the esophagus).
Medication may be prescribed by a doctor to neutralize stomach acid, decrease acid production, or strengthen the lower esophageal sphincter. The esophageal sphincter is the muscle that prevents stomach acid from coming up into the esophagus. Surgery may also be needed in these cases to reduce the size of the hernia, or to prevent strangulation by closing the opening in the diaphragm.
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