Diagnosis and Treatment of Hiatal Hernia

Hiatal hernia is a condition in which a portion of the stomach protrudes upward into the chest, through an opening in the diaphragm. Most small hiatal hernias don't cause problems, but a large hiatal hernia can allow food to back up into your esophagus, leading to chest pain and heartburn.

Hiatal hernias can occur in children or adults, and are more likely to occur in females than in males. People who are obese or have had abdominal surgery are at a higher risk for hernias. The risk also increases with age.

What causes hiatal hernias?

It may be due to heredity, while in others it may be caused by straining at stool, or exercising such as weightlifting. In some people, the hole in the diaphragm weakens and enlarges.

What are the symptoms?

Fifty percent of hiatal hernia patients don't experience any symptoms. For the other fifty percent symptoms may include:

Heartburn (worse when bending over or lying down shortly after a meal)
Vomiting
Gastric reflux (backflow of stomach contents into the esophagus)
A sour or bitter taste in the mouth
Frequent belching
Frequent hiccups
Feeling of pressure in the chest
Abdominal pressure soon after eating
Gas
Unexplained coughing
Difficulty swallowing

How is hiatal hernia diagnosed?

The doctor will ask if you've had any history of chest discomfort or heartburn, especially if you're symptoms seem to be related to lifting heavy objects, eating a big meal, or bending forward.

Based on your symptoms and risk factors (age, obesity, smoking, lifting heavy objects), the doctor may suspect a hiatal hernia. One or more of these tests may be ordered to confirm the diagnosis:

Chest x-ray
Esophagoscopy- A viewing tube is inserted down the throat to view the esophagus.
Manometry- This test measures pressure, to diagnose any abnormal muscle movements inside the esophagus.

Barium x-rays- The patient drinks a barium liquid, which coats the walls of the esophagus and stomach. X-rays are then taken, which can show if there is a hiatal hernia.

Upper endoscopy- This procedure is usually performed on an outpatient basis. The doctor applies a local anesthetic to the back of the throat. A sedative and pain reliever are given intravenously to produce a relaxed and drowsy feeling. A mouthpiece will be put in your mouth. You will be positioned on your left side and the doctor will insert the endoscope into your mouth, through your esophagus, and into your stomach.

After the procedure, you will spend about a half hour in the recovery room and may feel soreness in your throat. Lozenges will help the temporary soreness.

The doctor will send the results to your primary doctor.

What is the treatment?

The treatment for hiatal hernia is based on diet and surgery is rarely necessary. Your doctor may also recommend:

Restricting your intake of spicy and acidic food and drink

Cutting down or eliminating caffeinated beverages and chocolate

Eating small, frequent meals throughout the day

Using antacids and acid reducing medications

Elevating your head when lying down to prevent gastroesophageal reflux

You can help reduce your risk for developing a hiatal hernia with these self-care tips:

Follow a high fiber diet
Drink plenty of fluids to prevent constipation
Maintain a healthy weight
Avoid cigarette smoking, which can cause chronic coughs

A few people with hiatal hernia will need surgery if medication and lifestyle changes fail to relieve severe reflux symptoms. Large hiatal hernias may need repair if they cause shortness of breath, chest pain, or difficulty breathing or swallowing. Surgery is also indicated if you have complications such as a narrowing or obstructed esophagus, or chronic bleeding. With para-esophageal hernias, part of the stomach is squeezed into the chest beside the esophagus, complications can occur such as incarceration and strangulation. Incarceration means the hernia is stuck and being squeezed. If incarceration persists too long, surgery will be required. Strangulation results from loss of blood supply, leading to death of the tissues involved.

Laparoscopic surgery requires a shorter stay and less pain and scarring than a traditional thoracotomy or laparotomy. A laparoscope is a thin, hollow tube with a mini camera on the end. Surgical tools can be sent through the laparoscope and smaller cuts are used. The operation is performed while the surgeon views the images on a video monitor.