It is not clear why Hiatal hernias form. Though, it seems to be a result of weakened muscle tissue of the diaphragm which allows the stomach to push up into the chest cavity.
Certain causes that lead to its formation are:
- An injury in that area, a result of surgery or trauma.
- A large-sized hiatus at birth.
- The age-associated weakening of muscles surrounding the hiatus.
- Consistent and extreme pressure on the muscles around the hiatus, a consequence of vomiting, coughing, strained bowel movements, heavy weight-lifting, or rigorous exercising.
- Smoking and obesity can increase the risk of its occurrence.
The following diagnostic procedures could be recommended for the evaluation of a hiatal hernia:
X-ray of your upper digestive system: The patient is made to drink a chalky liquid, which coats and fills the inner lining of the digestive tract.
X-ray images of the coating now allow the doctor to see a silhouette of your oesophagus, stomach, and upper intestine and determine anomalies indicative of hiatal hernia.
Upper Endoscopy: A thin, flexible tube attached with a light and camera (endoscope) is introduced down the throat, to inspect the inside of the oesophagus and stomach to evaluate inflammation.
Esophageal Manometry: This test is used to measure the rhythmic contractions of the esophageal muscles while swallowing. This technique also measures the coordination and force exerted by the esophageal muscles.
Depending on the severity of the symptoms demonstrated the doctor may prescribe medications or surgery.
Medications for heartburn and acid reflux, the doctor may recommend:
- Antacids that neutralize stomach acid.
- Medications to lessen acid production.
- Medications deter acid production and allow the oesophagus to heal.
In addition to medication, the doctor may suggest several lifestyle changes that could lessen the severity of the symptoms or do away with the symptoms.
Although once diagnosed, checkups as per the periodicity of the doctor should be to avoid future complications.
If the medication fails to alleviate or resolve the symptoms of hiatal hernia or have complications like severe inflammation or narrowing of the oesophagus, surgery is recommended.
Open Surgery
The surgery for hiatal hernia repair involves positioning the stomach by pulling it down into the abdomen, restoring the optimal size of the diaphragm, rebuilding the esophageal sphincter, or cutting off the hernia sac.
Laparoscopic Surgery
The procedure can be done by several incisions (for the entry of a small camera and several surgical tools) in the abdomen. This is guided by the visual images from the small camera introduced through one of the incisions.
Thoracotomy
This surgery is done using a single incision in the chest wall.
Only large-sized Hiatal hernias are known to cause symptoms as listed below:
- Difficulty in swallowing.
- Regurgitation of food or liquid consumed back into the mouth.
- Shortness of breath.
- Reflux of stomach acid into the oesophagus.
- Heartburn which worsens on leaning or lying down.
- Abdominal or chest pain.
- Vomiting blood or passing black stools (an indicator of gastrointestinal bleeding).
It is advisable to see a doctor if there are signs of the above symptoms to avoid complications in the future.
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