The diaphragm normally has an opening called the esophageal hiatus, through which the esophagus passes and connects to the stomach.
In people with hiatal hernia, the upper part of the stomach pushes up through this opening into the chest cavity. Hiatal hernias can occur in people of any age, but they are more common in older adults.
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The condition is often asymptomatic, but some people may experience symptoms such as heartburn, chest pain, difficulty swallowing, and acid reflux. Other possible symptoms include belching, nausea, vomiting, shortness of breath, and bloating.
The symptoms of hiatal hernia can vary from person to person, and some people with hiatal hernia may not experience any symptoms at all. However, common symptoms of hiatal hernia may include:
Heartburn: This is a burning sensation in the chest that may be accompanied by a sour taste in the mouth or throat. Heartburn often occurs after meals, when lying down, or when bending over.
Chest Pain: This is a discomfort or pain in the chest, which may be confused with heart-related chest pain. However, hiatal hernia-related chest pain tends to be more localized and less severe.
Difficulty Swallowing: This is a feeling of food getting stuck in the throat or chest, and may be accompanied by coughing or choking.
Acid Reflux: This is when stomach acid flows back into the esophagus, causing a sour taste in the mouth or throat, and can lead to inflammation of the esophagus.
Belching: This is when air is expelled from the stomach through the mouth, and may be more frequent or excessive in people with hiatal hernia.
Nausea and Vomiting: These symptoms may occur due to the irritation of the stomach lining or esophagus.
Shortness of Breath: This can occur when the hernia puts pressure on the diaphragm, making it difficult to breathe deeply.
Barrett’s Esophagus: Barrett’s esophagus is a condition that develops in some people who have chronic gastroesophageal reflux disease (GERD). In GERD, stomach acid flows back into the esophagus, causing inflammation and irritation of the lining of the esophagus.
Hiatal hernia occurs when the upper part of the stomach bulges up into the chest cavity through an opening in the diaphragm.
The exact cause of hiatal hernia is not clear, but there are several factors that may contribute to its development, including:
Weakness in the Diaphragm Muscles: The diaphragm is a thin sheet of muscle that separates the chest cavity from the abdominal cavity. Weakness or injury to the diaphragm muscles can cause the stomach to push through the opening in the diaphragm, leading to a hiatal hernia.
Increased Pressure on the Abdominal Cavity: Factors that can increase pressure on the abdominal cavity, such as obesity, pregnancy, heavy lifting, or straining during bowel movements, can also contribute to the development of hiatal hernia.
Age: Hiatal hernia is more common in older adults, as the muscles in the diaphragm may weaken over time.
Genetics: Some studies suggest that hiatal hernia may run in families, indicating a genetic predisposition to the condition.
Smoking: Smoking weakens the muscles that help keep the stomach and esophagus in their proper positions, making it more likely for a hiatal hernia to develop.
Chronic Coughing or Vomiting: Chronic coughing or vomiting can put pressure on the muscles in the abdomen, increasing the risk of developing hiatal hernia.
The treatment options for hiatal hernia depend on the severity of the symptoms and the size of the hernia. Treatment may include lifestyle changes, medications, and in some cases, surgery.
Certain lifestyle changes may help reduce the symptoms of hiatal hernia, including:
Over-the-counter and prescription medications can help alleviate the symptoms of hiatal hernia, including:
Antacids: These medications can neutralize stomach acid and provide temporary relief from heartburn and acid reflux.
Proton Pump Inhibitors (PPIs): These medications reduce the amount of acid the stomach produces, providing longer-lasting relief from acid reflux symptoms.
H2 Blockers: These medications reduce the amount of acid the stomach produces, but are less effective than PPIs.
In some cases, surgery may be necessary to repair the hernia and alleviate symptoms. The surgical options include:
Laparoscopic Nissen Fundoplication: This procedure involves wrapping the upper part of the stomach around the lower part of the esophagus to reinforce the valve between the stomach and esophagus. This surgery is minimally invasive and typically has a shorter recovery time.
Laparoscopic Hiatal Hernia Repair: This procedure involves pulling the herniated part of the stomach down and repairing the hiatus with sutures. This surgery is also minimally invasive and has a shorter recovery time.
Open Surgery: This procedure involves making an incision in the abdomen to repair the hernia. This surgery is typically reserved for more complicated cases, and has a longer recovery time.