Hiatus Hernia


A hernia is a term used to describe when an organ or part protrudes through the tissue that contains it. The esophagus and stomach are connected through a small opening in the diaphragm (hiatus).

A hiatus hernia is when part of the stomach pushes up through the opening into the chest cavity causing problems.



Causes

  1. Age-related changes
  2. Surgical trauma
  3. Sudden or persistent intra-abdominal pressure (excessive coughing, vomiting, straining during urination or defecation)
Clinical features

Small Hiatal hernias are usually asymptomatic and may be discovered incidentally. However, in some cases, the following features may be seen

  1. Burning sensation or discomfort in the chest
  2. Reflux or regurgitation of food contents or stomach acid
  3. Discomfort while swallowing
  4. Early feeling of fullness
Evaluation
  1. Upper GI endoscopy to rule out gastritis or esophagitis
  2. Barium swallow
  3. Esophageal manometry
Treatment

1. Conservative - Most Hiatal Hernias are treated symptomatically 

(a)  Dietary Habit - Smaller meals spaced out rather than heavy meals, avoidance of spicy foods, avoidance of spicy foods, fried foods, and caffeinated drinks, and avoidance of lying down immediately before sleeping

(b)  Treatment with antacids like proton pump inhibitors (PPI's), H2 blockers, etc. which alleviate chest discomfort and reflux

2. Surgical correction is indicated in cases where the symptoms are refractory to conservative treatment or in rare cases of gastric volvulus.

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