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Hiatal Hernia

  • Hiatal hernia

Definition

Hiatal hernia is a condition in which the upper part of the stomach moves into the chest through the hole in the diaphragm. The diaphragm is the muscle that divides the chest cavity from the abdomen.

What is going on in the body?

The esophagus is the tube that carries food from the mouth to the stomach. It enters the abdominal cavity through a hole in the diaphragm called the esophageal hiatus. When a person has hiatal hernia, the diaphragmatic hiatus is usually weakened or larger than usual. At times, the upper part of the stomach can pass up through this larger-than-usual hole and into the chest cavity.

Risks

What are the causes and risks of the condition?

A hiatal hernia may be caused by:
  • constant, harsh coughing
  • vomiting
  • constipation and straining during bowel movements
  • sudden physical exertion
  • pregnancy
  • obesity
  • smoking
  • tight clothing around the abdomen
  • trauma, causing a hole or tear in the diaphragm
  • congenital abnormality, or weakness of the esophageal hiatus present at birth
  • esophageal cancer
  • medical procedures affecting the esophagus or diaphragm

Prevention

What can be done to prevent the condition?

A person can decrease his or her risk of hiatal hernia by:
  • staying at a healthy weight
  • limiting smoking and alcohol
  • eating a high fiber diet
  • not straining during bowel movements
  • using proper body mechanics, such as bending at the knees, during heavy lifting
  • wearing a seatbelt correctly
  • following sports safety guidelines for children, adolescents, and adults
Some causes of hiatal hernia cannot be prevented.

Diagnosed

How is the condition diagnosed?

After a complete history and physical, the healthcare provider may order:
  • ultrasound, a test that uses sound waves to see the diaphragm and stomach
  • endoscopy, a procedure that uses a long tube to look inside the esophagus
  • an upper GI series. In this test a person swallows liquid barium, and x-rays are taken to follow the course of the barium through the esophagus and into the stomach.

Long Term Effects

What are the long-term effects of the condition?

Hiatal hernias can cause gastroesophageal reflux disease (GERD). GERD is chronic reflux of stomach acid backing up into the esophagus. Ulcers or irritation of the lining of the esophagus and upper stomach can also occur. Strangulation of the esophagus or stomach may also occur with larger hiatal hernias.

Other Risks

What are the risks to others?

Hiatal hernia poses no risk to others.

Treatments

What are the treatments for the condition?

Treatment of hiatal hernia is focused on treating and reducing symptoms. To reduce symptoms, a person should:
  • sleep with the head of the bed raised several inches
  • avoid citrus fruits, spicy foods, alcohol, smoking, and caffeine (coffee, tea, chocolate)
  • eat small, frequent meals
  • maintain a healthy weight, or losing weight if obese
  • avoid eating within 2 hours before bedtime
  • avoid straining during bowel movements or heavy lifting
Medications that reduce acid production in the stomach or that make the stomach empty faster may help.
Surgery may be needed if symptoms are severe or persistent, or if there is a large hole in the diaphragm. The surgery is done to strengthen the diaphragm and decrease the size of the diaphragmatic hiatus.

Side Effects

What are the side effects of the treatments?

Medications that block stomach acid production can cause nausea, headache, or diarrhea. Surgery carries a risk of bleeding, infection, and allergic reactions to anesthesia.

After Treatment

What happens after treatment for the condition?

For mild intermittent symptoms, treatment with antacids, watching diet and activity may control hiatal hernia symptoms. For more serious recurrent symptoms, surgery may be needed. Recovery from surgery may be a few days to several weeks depending on the procedure used.

Monitor

How is the condition monitored?

Any new or worsening symptoms should be reported to the healthcare provider.

Sources

http://www.niddk.nih.gov/health/digest/pubs/heartbrn/heartbrn.htm#hiatal

Harrison's Principles of Internal Medicine, 1998, Fauci et al.

Complete Guide to Symptoms, Illness, and Surgery, H. Griffith, M.D., 2000

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