Hiatus Hernia

Hiatus hernia or hiatal hernia is the protrusion (or hernia ) of the upper part of the stomach into the thorax through a tear or weakness in the diaphragm . 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. Just below the diaphragm, the esophagus joins the stomach. The esophagus and stomach stay in their normal locations, but part of the stomach squeezes through the hiatus, landing it next to the esophagus. . 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. 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. Frequent reflux of stomach contents can lead to esophagitis , an inflammation of the lining of the esophagus. When severe, esophagitis can cause a stricture (narrowing) of the esophagus. The gastroesophageal junction acts as a barrier to prevent reflux of contents from the stomach into the esophagus by a combination of mechanisms forming the antireflux barrier. The esophagus and stomach stay in their normal locations, but part of the stomach squeezes through the hiatus, landing it next to the esophagus. 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 GERD without having a hiatal hernia. Commonly, the pouch of stomach may move up or down through the hiatus, producing a 'sliding hiatus hernia'.

If the problem is not repaired, the stomach or other abdominal contents may bulge (herniate) into the chest, causing heartburn (acid reflux) and serious damage to the esophagus. The esophagus and stomach stay in their normal locations, but part of the stomach squeezes through the hiatus, landing it next to the esophagus. In such cases, epigastric discomfort and, occasionally, dysphagia may occur; however, no reflux symptoms are evident because the cardiac mechanism is not disturbed. Occasionally, a gastric ulcer on the lesser curve may be associated at the level of the diaphragmatic hiatus. Just below this is a slightly dilated part of the esophagus, forming the vestibule. If the acid damages the lining of the lower part of the gullet then this is called oesophagitis but there is surprisingly little correlation between the amount of heartburn and the degree of oesophagitis. If the acid damages the lining of the lower part of the gullet then this is called oesophagitis but there is surprisingly little correlation between the amount of heartburn and the degree of oesophagitis. People with a hiatal hernia may experience chest pain that can easily be confused with the pain of a heart attack With weakening and enlargement however, the opening (or herniation) can allow upward passage or even entrapment of the upper stomach above the diaphragm.

Causes of Hiatus Hernia

The common causes of Hiatus Hernia :-

• Burkitt et al suggest that the Western, fiber-depleted diet leads to a state of chronic constipation and straining during bowel movement, which might explain the higher incidence of this condition in Western countries.
• Conditions such as chronic esophagitis may cause shortening of the esophagus by causing fibrosis of the longitudinal muscles and, therefore, predispose to hiatal hernia
• Frequent bending over or heavy lifting
• Poor seated posture (such as slouching)
• Straining with constipation
• The most frequent cause of hiatal hernia is an increased pressure in the abdominal cavity produced by coughing, vomiting, straining at stool or sudden physical exertion
• . The presence of abdominal ascites also is associated with hiatal hernias.

Symptoms of Hiatus Hernia

Some are common symptoms of Hiatus Hernia :-

• The symptoms include acid reflux , pains , similar to heartburn, in the chest and upper stomach.
• Rarely, with a fixed hiatal hernia, the blood supply is cut off to the trapped portion of the stomach, causing great pain and serious illness.
• At times, a hiatal hernia causes chest pain or upper abdominal pain when the stomach becomes trapped above the diaphragm through the narrow esophageal hiatus.
• Symptoms of a strangulated hiatal hernia include sudden severe chest pain and difficulty swallowing
• Bleeding from the stomach or esophagus
• pain in the upper abdomen and chest, feeling sick, an acid taste in the mouth, bloating, belching, and a burning pain when you swallow hot drinks.
• Severe chest pain develops in some cases (and may be mistaken for a heart attack).

Treatment of Hiatus Hernia

• The treatment of GERD is beyond the scope of this article and is discussed in Gastroesophageal Reflux Disease .
• Surgery is necessary only in the minority of patients with complications of GERD despite aggressive treatment with proton pump inhibitors (PPIs).
• Sliding hiatal hernias usually do not cause symptoms and do not require treatment.
• If lifestyle changes do not relieve the symptoms, your doctor will suggest antacids or acid blockers.
• Rarely, a hiatus hernia causes severe symptoms of reflux which are not helped so well with medication.
• A transthoracic approach may be used in patients who have had a previous Nissen wrap or those who have an irreducible hernia.
• Lifestyle changes for a hiatal hernia include diet modification , not smoking , avoiding alcohol , and taking measures to reduce acid reflux during the day and acid reflux at night .
  

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