What Is “Hiatal Hernia” In English? A Comprehensive Guide
A hiatal hernia is a condition where a portion of the stomach protrudes through the hiatus, an opening in the diaphragm, into the chest cavity. It’s a common condition, and this article will delve into its causes, symptoms, diagnosis, and treatment options.
Understanding the Hiatal Hernia
A hiatal hernia occurs when the upper part of your stomach pushes up through the diaphragm, the muscle that separates your abdomen from your chest. The diaphragm has a small opening (hiatus) through which your esophagus passes before connecting to your stomach. When the stomach pushes through this opening, it creates a hiatal hernia. While small hiatal hernias usually don’t cause problems, larger ones can allow food and acid to back up into your esophagus, leading to heartburn and other symptoms.
Types of Hiatal Hernias
There are two main types of hiatal hernias:
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Sliding hiatal hernia: This is the more common type. It occurs when the stomach and the esophagus slide up into the chest through the hiatus. This type tends to be small and often doesn’t cause any symptoms.
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Paraesophageal hiatal hernia: In this type, the esophagus and stomach stay in their normal locations, but part of the stomach squeezes through the hiatus and lies next to the esophagus. This type can be more serious because the stomach can become constricted or have its blood supply cut off.
Here’s a table summarizing the differences:
Feature Sliding Hiatal Hernia Paraesophageal Hiatal Hernia Prevalence More Common Less Common Mechanism Stomach & Esophagus slide up Part of Stomach pushes up Severity Usually less severe Potentially more severe Complications Less common Higher risk of complications
Causes and Risk Factors
The exact cause of a hiatal hernia is often unknown, but several factors can contribute to its development:
- Age-related changes: As we age, the diaphragm can weaken, making it easier for the stomach to push through.
- Congenital defects: Some people are born with a larger than normal hiatus.
- Injury: Trauma to the area, such as from surgery or an accident, can weaken the diaphragm.
- Persistent intense pressure on the surrounding muscles: This can be caused by frequent coughing, vomiting, straining during bowel movements, or heavy lifting.
- Obesity: Excess weight puts additional pressure on the abdomen.
Symptoms and Complications
Many small hiatal hernias cause no signs or symptoms. Larger hiatal hernias can cause:
- Heartburn
- Regurgitation of food or liquids into the mouth
- Acid reflux
- Difficulty swallowing
- Chest or abdominal pain
- Feeling full quickly when eating
- Shortness of breath
- Vomiting of blood or passing of black stools (which may indicate gastrointestinal bleeding)
Complications can include:
- Esophagitis: Inflammation of the esophagus.
- Stricture: Narrowing of the esophagus.
- Barrett’s esophagus: Changes to the lining of the esophagus that can increase the risk of esophageal cancer.
- Strangulation: In a paraesophageal hernia, the stomach can become trapped, cutting off its blood supply. This is a medical emergency.
- Anemia: From slow bleeding.
Diagnosis and Treatment
A hiatal hernia is often discovered during tests to determine the cause of heartburn or chest pain. These tests may include:
- Barium swallow: You drink a barium solution, which coats the esophagus and stomach, making them visible on an X-ray.
- Endoscopy: A thin, flexible tube with a camera is inserted down the esophagus to visualize the lining of the esophagus and stomach.
- Esophageal manometry: This test measures the pressure and muscle contractions in the esophagus.
Treatment depends on the severity of your symptoms. Options include:
- Lifestyle changes:
- Eating smaller meals
- Avoiding foods that trigger heartburn (e.g., fatty foods, caffeine, alcohol, chocolate)
- Not lying down after eating
- Elevating the head of your bed
- Losing weight if overweight or obese
- Medications:
- Antacids to neutralize stomach acid
- H2 blockers to reduce stomach acid production
- Proton pump inhibitors (PPIs) to block stomach acid production
- Surgery: Surgery may be necessary if medications don’t work or if you develop complications. The surgery usually involves pulling the stomach down into the abdomen and making the opening in the diaphragm smaller.
Frequently Asked Questions (FAQs) About Hiatal Hernias
What is the connection between acid reflux and a hiatal hernia?
A hiatal hernia can weaken the lower esophageal sphincter (LES), the muscle that prevents stomach acid from flowing back into the esophagus. When the LES doesn’t close properly, acid reflux is more likely to occur. The hernia can create a pocket above the diaphragm, trapping acid and increasing the risk of reflux.
Can a hiatal hernia cause shortness of breath?
Yes, a large hiatal hernia can press on the lungs and diaphragm, making it difficult to breathe deeply. Also, acid reflux associated with the hernia can irritate the airways, leading to bronchospasm and shortness of breath.
Are there any natural remedies for a hiatal hernia?
While natural remedies cannot cure a hiatal hernia, they can help manage symptoms. These include things such as: lifestyle modifications (as discussed above), eating smaller meals, elevating the head of your bed, and avoiding trigger foods. Some people find relief with herbal remedies like ginger or chamomile tea, but always consult with a healthcare professional before trying any new treatments.
Is it possible to live a normal life with a hiatal hernia?
Yes, many people with a hiatal hernia live normal lives. With appropriate lifestyle changes and medication, symptoms can be well-managed. Regular check-ups with your doctor are important to monitor the condition.
Does weightlifting cause hiatal hernias?
While weightlifting itself doesn’t directly cause a hiatal hernia, the straining and increased abdominal pressure associated with heavy lifting can contribute to the weakening of the diaphragm over time, potentially increasing the risk, especially in those already predisposed.
How is a paraesophageal hernia different from a sliding hiatal hernia?
A sliding hiatal hernia involves the stomach and esophagus sliding up into the chest, while a paraesophageal hiatal hernia sees part of the stomach pushing up alongside the esophagus. The paraesophageal type is often more serious due to the risk of strangulation.
Can stress worsen the symptoms of a hiatal hernia?
Yes, stress can worsen symptoms of acid reflux, which are often associated with a hiatal hernia. Stress can increase stomach acid production and slow digestion, leading to more frequent and severe heartburn.
When is surgery necessary for a hiatal hernia?
Surgery is generally considered when medications and lifestyle changes are ineffective in controlling symptoms, or when complications such as strangulation or severe esophagitis develop.
What is Nissen fundoplication?
Nissen fundoplication is a surgical procedure used to treat acid reflux and hiatal hernia. It involves wrapping the upper part of the stomach (the fundus) around the lower esophagus to reinforce the LES.
Can a hiatal hernia cause chest pain that mimics a heart attack?
Yes, the chest pain associated with a hiatal hernia and acid reflux can sometimes mimic the pain of a heart attack. It’s crucial to seek immediate medical attention if you experience chest pain to rule out any cardiac issues.
What foods should I avoid if I have a hiatal hernia?
Common trigger foods for acid reflux include fatty foods, fried foods, spicy foods, citrus fruits, tomatoes, chocolate, caffeine, alcohol, and carbonated beverages. Keeping a food diary can help you identify your personal trigger foods.
Is there a genetic component to hiatal hernias?
While the exact role of genetics is not fully understood, there may be a genetic predisposition to developing a hiatal hernia. People with a family history of hiatal hernias may be at a slightly higher risk.