What is Hiatus Hernia or Hiatal Hernia?
A hiatus hernia or hiatal hernia is the protrusion (or herniation) of the upper part of the stomach into the thoraxthrough a tear or weakness in the diaphragm. Hiatus hernias often result in heartburn but may also cause chest pain or pain with eating.
The most common cause is obesity. The diagnosis is often by endoscopy or medical imaging. A hiatus hernia may be treated with lifestyle changes such as raising the head of the bed, weight loss, and adjusting eating habits. Medications such as H2 blockers or proton pump inhibitors may help. If the symptoms do not improve with medications the surgery known as may be an option.
What are Signs and Symptoms of Hiatus Hernia?
Hiatal hernia has often been called the “great mimic” because its symptoms can resemble many disorders. For example, a person with this problem can experience dull pains in the chest, shortness of breath (caused by the hernia’s effect on the diaphragm), heart palpitations (due to irritation of the vagus nerve), and swallowed food “balling up” and causing discomfort in lower esophagus until it passes on to stomach.
In most cases however, a hiatal hernia does not cause any symptoms. The pain and discomfort that a patient experiences is due to the reflux of gastric acid, air, or bile. While there are several causes of acid reflux, it does happen more frequently in the presence of hiatal hernia.
For newborn the presence of Bochdalek hernia can be recognised from symptoms such as difficulty breathing fast respiration, increased heart rate and blue skin.
The following are risk factors that can result in a hiatus hernia
Increased pressure within the abdomen caused by:
• Heavy lifting or bending over
• Frequent or hard coughing
• Hard sneezing
• Violent vomiting
How is the diagnosis done of Hiatus Hernia ?
The diagnosis of a hiatus hernia is typically made through an upper GI series, endoscopy or high resolution manometry.
• A large hiatus hernia on X-ray marked by open arrows in contrast to the heart borders marked by closed arrows
• Upper GI endoscopy depicting hiatus hernia
• A hiatus hernia as seen on CT
Classification and types of Hiatus Hernia
Schematic diagram of different types of hiatus hernia. Green is the esophagus, red is the stomach, purple is the diaphragm, blue is the HIS-angle. A is the normal anatomy, B is a pre-stage, C is a sliding hiatal hernia, and D is a paraesophageal (rolling) type.
Three types of esophageal hiatal hernia are identified:
characterized by an upward herniation of the cardia and GE junction in the posterior mediastinum. The most common one.
(rolling or paraesophageal) hernia (PEH)
characterized by an upward herniation of both the cardia and the gastric fundus.
(combined sliding-rolling or mixed) hernia
characterized by an upward herniation of the cardia and GE junction in the posterior mediastinum. The most common one. (C)
is declared in some taxonomies, when an additional organ, usually the colon, herniates as well.The end stage of type I and type II hernias occurs when the whole stomach migrates up into the chest by rotating 180° around its longitudinal axis, with the cardia and pylorus as fixed points. In this situation the abnormality is usually referred to as an intrathoracic stomach.
In most cases, sufferers experience no discomfort and no treatment is required. If there is pain or discomfort, 3 or 4 sips of room temperature water will usually relieve the pain.
However, when the hiatal hernia is large, or is of the paraesophageal type, it is likely to cause esophageal stricture and discomfort. Symptomatic patients should elevate the head of their beds and avoid lying down directly after meals. If the condition has been brought on by stress, stress reduction techniques may be prescribed, or if overweight, weight loss may be indicated. Medications that reduce the lower esophageal sphincter (LES) pressure should be avoided. Antisecretory drugs like proton pump inhibitors and H2 receptor blockers can be used to reduce acid secretion.
Where hernia symptoms are severe and chronic acid reflux is involved, surgery is sometimes recommended, as chronic reflux can severely injure the esophagus and even lead to esophageal cancer.
The surgical procedure used is called Nissen fundoplication. In fundoplication, the gastric fundus (upper part) of the stomach is wrapped, or plicated, around the inferior part of the esophagus, preventing herniation of the stomach through the hiatus in the diaphragm and the reflux of gastric acid. The procedure is now commonly performed laparoscopically. With proper patient selection, laparoscopic fundoplication recent studies have indicated low complication rates, quick recovery, and relatively good long term results.
Cost of Hiatus Hernia Surgery
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